senate Bill S6917

2013-2014 Legislative Session

Redefines "small group" for the purposes of sections 3231 and 4317 of the insurance law

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Archive: Last Bill Status - Passed Senate


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jun 19, 2014 referred to insurance
delivered to assembly
passed senate
May 07, 2014 advanced to third reading
May 06, 2014 2nd report cal.
May 05, 2014 1st report cal.492
Mar 31, 2014 referred to insurance

Votes

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S6917 - Bill Details

See Assembly Version of this Bill:
A9980
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3231 & 4317, Ins L

S6917 - Bill Texts

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Redefines "small group" for the purposes of certain provisions of sections 3231 and 4317 of the insurance law.

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BILL NUMBER:S6917

TITLE OF BILL: An act to amend the insurance law, in relation to
rating of individual and small group health insurance contracts and
policies

PURPOSE:

To amend the insurance law to preserve the current stop loss insurance
market.

SUMMARY OF PROVISIONS:

Section 1 of the bill provides an exception to the definition of small
group coverage when coverage is written by a commercial insurer.

Section 2 of the bill provides that the prohibition against a
commercial insurer acting as a third party administrator or providing
stop loss coverage to self-funded small groups would continue to apply
only to small groups of fifty or fewer employees or members.

Section 3 of the bill provides an exception to the definition of small
group coverage when coverage is written by a corporation organized
under Article 43 of the Insurance Law.

Section 4 of the bill provides that the prohibition against an Article
43 corporation acting as a third party administrator or providing stop
loss coverage to self-funded small groups would continue to apply only
to small groups of fifty or fewer employees or members.

Section 5 of the bill sets forth the effective date.

JUSTIFICATION:

Since 1993, insurance companies have been permitted to write stop loss
insurance and to provide administrative services to self-funded
employer groups with 51 or more employees. A redefinition of what
constitutes a small group, designed to comply with the federal
Affordable Care Act, had the inadvertent effect of prohibiting
insurers from continuing to issue stop loss coverage to groups with
between 51 and 100 employees effective 2016. This bill will allow the
current stop loss marketplace to operate uninterrupted for
self-insured groups without directly impacting the insured small group
market.

LEGISLATIVE HISTORY:

New bill.

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

Immediately.


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                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  6917

                            I N  S E N A T E

                             March 31, 2014
                               ___________

Introduced  by  Sen.  SEWARD -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law, in relation to rating  of  individual
  and small group health insurance contracts and policies

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph 1 of subsection (a) of section 3231 of the insur-
ance law, as amended by section 69 of part D of chapter 56 of  the  laws
of 2013, is amended to read as follows:
  (1)  No  individual health insurance policy and no group health insur-
ance policy covering between one and fifty employees or members  of  the
groupr,  EXCEPT  AS  SET  FORTH  IN  SUBSECTION  (H) OF THIS SECTION, or
between one and one hundred employees or members of the group for  poli-
cies  issued  or renewed on or after January first, two thousand sixteen
exclusive of spouses and dependents, hereinafter referred to as a  small
group,  providing  hospital  and/or medical benefits, including medicare
supplemental insurance, shall be issued in this state unless such policy
is community rated and, notwithstanding any other provisions of law, the
underwriting of such policy involves no more than the  imposition  of  a
pre-existing  condition  limitation if otherwise permitted by this arti-
cle.
  S 2. Paragraph 1 of subsection (h) of section 3231  of  the  insurance
law,  as added by chapter 501 of the laws of 1992, is amended to read as
follows:
  (1) Notwithstanding any other provision of this chapter,  no  insurer,
subsidiary  of  an  insurer,  or  controlled person of a holding company
system may act as an administrator or claims paying agent, as opposed to
an insurer, on behalf of small groups which, if  they  purchased  insur-
ance,  would  be  subject  to this section. No insurer, subsidiary of an
insurer, or controlled person of a  holding  company  may  provide  stop
loss,  catastrophic  or  reinsurance  coverage to small groups which, if
they purchased insurance, would be subject to this section. FOR PURPOSES
OF THIS SUBSECTION, "SMALL  GROUP"  SHALL  MEAN  A  GROUP  COMPRISED  OF

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD14480-01-4

S. 6917                             2

BETWEEN  ONE  AND  FIFTY  EMPLOYEES OR MEMBERS, EXCLUSIVE OF SPOUSES AND
DEPENDENTS.
  S  3.  Paragraph  1 of subsection (a) of section 4317 of the insurance
law, as amended by section 72 of part D of chapter 56  of  the  laws  of
2013, is amended to read as follows:
  (1) No individual health insurance contract and no group health insur-
ance contract covering between one and fifty employees or members of the
group, EXCEPT AS SET FORTH IN SUBSECTION (E) OF THIS SECTION, or between
one  and  one  hundred  employees  or  members of the group for policies
issued or renewed on or after January first, two thousand sixteen exclu-
sive of spouses and dependents, including contracts for which the premi-
ums are paid by a remitting agent for a group, hereinafter  referred  to
as  a small group, providing hospital and/or medical benefits, including
Medicare supplemental insurance, shall be issued in  this  state  unless
such   contract  is  community  rated  and,  notwithstanding  any  other
provisions of law, the underwriting of such contract  involves  no  more
than  the imposition of a pre-existing condition limitation if otherwise
permitted by this article.
  S 4. Paragraph 1 of subsection (e) of section 4317  of  the  insurance
law,  as  amended  by  section 72 of part D of chapter 56 of the laws of
2013, is amended to read as follows:
  (1) Notwithstanding any other provision of this chapter,  no  insurer,
subsidiary  of  an  insurer,  or  controlled person of a holding company
system may act as an administrator or claims paying agent, as opposed to
an insurer, on behalf of small groups which, if  they  purchased  insur-
ance,  would  be  subject  to this section. No insurer, subsidiary of an
insurer, or controlled person of a  holding  company  may  provide  stop
loss,  catastrophic  or  reinsurance  coverage to small groups which, if
they purchased insurance,  would  be  subject  to  this  section.    FOR
PURPOSES  OF THIS SUBSECTION, "SMALL GROUP" SHALL MEAN A GROUP COMPRISED
OF BETWEEN ONE AND FIFTY EMPLOYEES OR MEMBERS, EXCLUSIVE OF SPOUSES  AND
DEPENDENTS.
  S 5. This act shall take effect immediately.

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