S T A T E O F N E W Y O R K
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172
2019-2020 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 9, 2019
___________
Introduced by M. of A. CAHILL, GARBARINO, STIRPE, HEVESI, MAGNARELLI,
ZEBROWSKI, STECK, QUART, RAIA, FRIEND, KOLB -- Multi-Sponsored by --
M. of A. FITZPATRICK, STEC -- read once and referred 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-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01889-01-9
A. 172 2
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
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,
A. 172 3
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
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.