NY State Senate Bill 2017-S8500

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 09, 2018	referred to insurance

2017-S8500 (ACTIVE) - Details

See Assembly Version of this Bill:: A99
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3231 & 4317, Ins L
Versions Introduced in Other Legislative Sessions:: 2013-2014: S6917, A9980
2015-2016: S2366, A1154
2019-2020: A172
2021-2022: A1039

2017-S8500 (ACTIVE) - Summary

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

2017-S8500 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S8500

SPONSOR: SEWARD
 
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:

This bill would 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 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 4 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 5 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 6 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 7 establishes 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:

2015-2016: S.2366 - Passed Senate

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2017-S8500 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8500
 
                             I N  S E N A T E
 
                                May 9, 2018
                                ___________
 
 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
 group, EXCEPT AS SET FORTH IN SUBSECTION (H) 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,  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.
   § 2. Paragraph 1 of subsection (h) of section 3231  of  the  insurance
 law, as amended by chapter 12 of the laws of 2016, 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  may  provide  stop
 loss,  catastrophic  or  reinsurance  coverage to small groups which, if
 they purchased insurance, would be subject to  this  section.  Provided,
 however,  the  provisions  of this paragraph shall not apply to: (A) the
 renewal of stop loss, catastrophic or reinsurance coverage issued and in
 effect on January first, two thousand fifteen to small  groups  covering
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD01398-02-8

 S. 8500                             2
 
 between fifty-one and one hundred employees or members of the group; and
 (B)  the issuance between January first, two thousand sixteen and Decem-
 ber thirty-first, two thousand sixteen, of stop  loss,  catastrophic  or
 reinsurance coverage, and any renewal thereof, to a small group covering
 between  fifty-one  and  one  hundred employees or members of the group,
 provided that such group had  stop  loss,  catastrophic  or  reinsurance
 coverage  issued  and  in effect on January first, two thousand fifteen.
 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.
   § 3. 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
 BETWEEN  ONE  AND  FIFTY  EMPLOYEES OR MEMBERS, EXCLUSIVE OF SPOUSES AND
 DEPENDENTS.
   § 4. 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.
   §  5.  Paragraph  1 of subsection (e) of section 4317 of the insurance
 law, as amended by chapter 12 of the laws of 2016, 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 may provide stop
 loss, catastrophic or reinsurance coverage to  small  groups  which,  if
 they  purchased  insurance,  would be subject to this section. Provided,
 however, the provisions of this paragraph shall not apply  to:  (A)  the
 renewal of stop loss, catastrophic or reinsurance coverage issued and in
 effect  on  January first, two thousand fifteen to small groups covering
 between fifty-one and one hundred employees or members of the group; and
 (B) the issuance between January first, two thousand sixteen, and Decem-
 ber thirty-first, two thousand sixteen, of stop  loss,  catastrophic  or

 S. 8500                             3
 
 reinsurance coverage, and any renewal thereof, to a small group covering
 between  fifty-one  and  one  hundred employees or members of the group,
 provided that such group had  stop  loss,  catastrophic  or  reinsurance
 coverage  issued  and  in effect on January first, two thousand fifteen.
 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.
   § 6. 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.
   §  7.  This  act  shall take effect immediately; provided, however the
 amendments to paragraph 1 of subsection  (h)  of  section  3231  of  the
 insurance  law  made  by section two of this act shall be subject to the
 expiration and reversion of such paragraph  pursuant  to  section  5  of
 chapter  588  of  the  laws of 2015, as amended, when upon such date the
 provisions of section three of this act shall take effect; and provided,
 further, the amendments to paragraph 1 of subsection (e) of section 4317
 of the insurance law made by section five of this act shall  be  subject
 to  the expiration and reversion of such paragraph pursuant to section 5
 of chapter 588 of the laws of 2015, as amended, when upon such date  the
 provisions of section six of this act shall take effect.

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Senate Bill S8500

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

2017-S8500 (ACTIVE) - Details

2017-S8500 (ACTIVE) - Summary

2017-S8500 (ACTIVE) - Sponsor Memo

2017-S8500 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S8500

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Sponsored By

James L. Seward

Archive: Last Bill Status - In Senate Committee Insurance Committee

2017-S8500 (ACTIVE) - Details

2017-S8500 (ACTIVE) - Summary

2017-S8500 (ACTIVE) - Sponsor Memo

2017-S8500 (ACTIVE) - Bill Text download pdf

Comments