S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    206
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 9, 2019
                                ___________
 
 Introduced by M. of A. CAHILL, STECK, SCHIMMINGER, RAIA -- 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 policies

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Subparagraph  (A)  of  paragraph  1  of subsection (e) of
 section 3231 of the insurance law, as amended by chapter 107 of the laws
 of 2010 and as further amended by section 104 of part A of chapter 62 of
 the laws of 2011, is amended to read as follows:
   (A) An insurer desiring to increase or decrease premiums for any poli-
 cy form subject to this section shall submit a rate filing  or  applica-
 tion to the superintendent.
   An  insurer shall send written notice of the proposed rate adjustment,
 [including the specific change requested,] to  each  policy  holder  and
 certificate  holder affected by the adjustment on or before the date the
 rate filing or application  is  submitted  to  the  superintendent.  The
 notice  shall prominently include mailing and website addresses for both
 the department of financial services and the  insurer  through  which  a
 person may, within thirty days from the date the rate filing or applica-
 tion  is  submitted  to  the  superintendent,  contact the department of
 financial services or insurer to receive additional  information  or  to
 submit  written  comments to the department of financial services on the
 rate filing or application. The superintendent shall establish a process
 to post on the department's website, in a timely  manner,  all  relevant
 written  comments  received  pertaining to rate filings or applications.
 The insurer shall provide a copy of the  notice  to  the  superintendent
 with the rate filing or application. The superintendent shall immediate-
 ly  cause  the  notice  to  be  posted  on  the  department of financial
 services' website. The superintendent shall determine whether the filing
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD00054-01-9

 A. 206                              2
 
 or application shall become effective as filed, shall  become  effective
 as  modified,  or shall be disapproved. The superintendent may modify or
 disapprove the rate filing or application if  the  superintendent  finds
 that  the  premiums are unreasonable, excessive, inadequate, or unfairly
 discriminatory, and may consider the financial condition of the  insurer
 when  approving, modifying or disapproving any premium adjustment. [The]
 PROVIDED, HOWEVER, ANY ADJUSTMENT TO A RATE FILING OR  APPLICATION  MUST
 BE  IN ACCORDANCE WITH GENERALLY ACCEPTED ACTUARIAL PRINCIPLES AND PRAC-
 TICES, AND MUST BE APPROPRIATE FOR THE  POPULATION  TO  BE  COVERED  AND
 SERVICES TO BE FURNISHED UNDER THE POLICY. AN INITIAL determination [of]
 REGARDING  THE  RATE  FILING  OR APPLICATION SHALL BE MADE BY the super-
 intendent [shall be supported by sound actuarial assumptions  and  meth-
 ods, and shall be rendered in writing between] NO LATER THAN thirty [and
 sixty] days from the date the rate filing or application is submitted to
 the  superintendent. THE SUPERINTENDENT'S INITIAL DETERMINATION SHALL BE
 PROVIDED TO AN INSURER IN WRITING WITHIN THE THIRTY DAY TIME PERIOD  AND
 SHALL  DESCRIBE  IN DETAIL THE ACTUARIAL ASSUMPTIONS AND METHODS USED IN
 THE SUPERINTENDENT'S DETERMINATION. Should  the  superintendent  require
 additional  information from the insurer in order to make [a] AN INITIAL
 determination, the superintendent shall require the insurer  to  furnish
 such  information,  and  in such event, the [sixty] THIRTY days shall be
 tolled and shall resume as of the date the insurer furnishes the  infor-
 mation to the superintendent. [If the superintendent requests additional
 information  less  than  ten  days from the expiration of the sixty days
 (exclusive of tolling), the superintendent  may  extend  the  sixty  day
 period an additional twenty days to make a determination. The] FOLLOWING
 THE ISSUANCE OF THE INITIAL DETERMINATION, AN INSURER SHALL HAVE FIFTEEN
 DAYS TO APPEAL THE DETERMINATION IN WRITING. IF AN INITIAL RATE DETERMI-
 NATION  IS APPEALED, THE SUPERINTENDENT SHALL HAVE FIFTEEN DAYS TO ISSUE
 A REVISED DETERMINATION. IF THE INITIAL DETERMINATION IS NOT APPEALED BY
 AN INSURER, IT SHALL BECOME FINAL FIFTEEN DAYS AFTER IT IS  ISSUED.  ALL
 FINAL RATE DETERMINATIONS SHALL BE CERTIFIED BY AN ACTUARY DESIGNATED BY
 THE  SUPERINTENDENT WHO MEETS THE QUALIFICATION STANDARDS ESTABLISHED BY
 THE AMERICAN ACADEMY OF ACTUARIES  AND  FOLLOW  THE  PRACTICE  STANDARDS
 ESTABLISHED  BY THE ACTUARIAL STANDARDS BOARD. NOTWITHSTANDING THE FORE-
 GOING, THE application or rate filing  will  be  deemed  approved  if  a
 determination  is  not  rendered  within  the  time  allotted under this
 section. An insurer shall  not  implement  a  rate  adjustment  THAT  IS
 APPROVED  BY  THE  SUPERINTENDENT  unless  the insurer provides at least
 [sixty] THIRTY days  advance  [written]  notice  of  the  [premium  rate
 adjustment  approved by the superintendent] ADJUSTMENT, EITHER THROUGH A
 POSTING ON ITS WEBSITE OR BY WRITTEN NOTICE to each  policy  holder  and
 certificate holder affected by the rate adjustment.
   §  2.  Paragraph  2 of subsection (c) of section 4308 of the insurance
 law, as amended by chapter 107 of  the  laws  of  2010  and  as  further
 amended  by  section 104 of part A of chapter 62 of the laws of 2011, is
 amended to read as follows:
   (2) A corporation desiring to increase or decrease  premiums  for  any
 contract subject to this subsection shall submit a rate filing or appli-
 cation to the superintendent. A corporation shall send written notice of
 the proposed rate adjustment, [including the specific change requested,]
 to  each contract holder and subscriber affected by the adjustment on or
 before the date the rate filing  or  application  is  submitted  to  the
 superintendent. The notice shall prominently include mailing and website
 addresses  for  both the department of financial services and the corpo-
 ration through which a person may, within thirty days from the date  the

 A. 206                              3
 
 rate  filing  or application is submitted to the superintendent, contact
 the department of financial services or  corporation  to  receive  addi-
 tional  information  or  to submit written comments to the department of
 financial services on the rate filing or application. The superintendent
 shall  establish  a  process  to  post on the department's website, in a
 timely manner, all relevant written comments received pertaining to rate
 filings or applications. The corporation shall provide  a  copy  of  the
 notice  to  the  superintendent with the rate filing or application. The
 superintendent shall immediately cause the notice to be  posted  on  the
 department  of  financial  services'  website.  The superintendent shall
 determine whether the filing or application shall  become  effective  as
 filed,  shall become effective as modified, or shall be disapproved. The
 superintendent may modify or disapprove the rate filing  or  application
 if  the  superintendent finds that the premiums are unreasonable, exces-
 sive, inadequate, or  unfairly  discriminatory,  and  may  consider  the
 financial condition of the corporation in approving, modifying or disap-
 proving any premium adjustment[. The]; PROVIDED, HOWEVER, ANY ADJUSTMENT
 TO  A  RATE  FILING  OR APPLICATION MUST BE IN ACCORDANCE WITH GENERALLY
 ACCEPTED ACTUARIAL PRINCIPLES AND PRACTICES, AND MUST BE APPROPRIATE FOR
 THE POPULATION TO BE COVERED AND SERVICES  TO  BE  FURNISHED  UNDER  THE
 CONTRACT.  AN INITIAL determination [of] REGARDING THE RATE OF FILING OR
 APPLICATION SHALL BE MADE BY the superintendent [shall be  supported  by
 sound  actuarial assumptions and methods, and shall be rendered in writ-
 ing between] NO LATER THAN thirty [and sixty] days  from  the  date  the
 rate  filing  or  application  is  submitted  to the superintendent. THE
 SUPERINTENDENT'S INITIAL DETERMINATION SHALL BE  PROVIDED  TO  A  CORPO-
 RATION  IN  WRITING WITHIN THE THIRTY DAY TIME PERIOD AND SHALL DESCRIBE
 IN DETAIL THE ACTUARIAL ASSUMPTIONS AND METHODS USED IN THE  SUPERINTEN-
 DENT'S  DETERMINATION.  Should  the  superintendent  require  additional
 information from the corporation in order to make [a] AN INITIAL  deter-
 mination,  the  superintendent  shall require the corporation to furnish
 such information, and in such event, the [sixty] THIRTY  days  shall  be
 tolled  and  shall  resume  as of the date the corporation furnishes the
 information to the superintendent. [If the superintendent requests addi-
 tional information less than ten days from the expiration of  the  sixty
 days (exclusive of tolling), the superintendent may extend the sixty day
 period an additional twenty days, to make a determination.  The] FOLLOW-
 ING  THE ISSUANCE OF THE INITIAL DETERMINATION, A CORPORATION SHALL HAVE
 FIFTEEN DAYS TO APPEAL THE DETERMINATION IN WRITING. IF AN INITIAL  RATE
 DETERMINATION IS APPEALED, THE SUPERINTENDENT SHALL HAVE FIFTEEN DAYS TO
 ISSUE  A  REVISED  DETERMINATION.    IF THE INITIAL DETERMINATION IS NOT
 APPEALED BY A CORPORATION, IT SHALL BECOME FINAL FIFTEEN DAYS  AFTER  IT
 IS  ISSUED. ALL FINAL RATE DETERMINATIONS SHALL BE CERTIFIED BY AN ACTU-
 ARY DESIGNATED BY THE SUPERINTENDENT WHO MEETS THE QUALIFICATION  STAND-
 ARDS  ESTABLISHED  BY  THE  AMERICAN ACADEMY OF ACTUARIES AND FOLLOW THE
 PRACTICE  STANDARDS  ESTABLISHED  BY  THE  ACTUARIAL  STANDARDS   BOARD.
 NOTWITHSTANDING  THE  FOREGOING,  THE application or rate filing will be
 deemed approved if a determination  is  not  rendered  within  the  time
 allotted  under  this  section. A corporation shall not implement a rate
 adjustment THAT IS APPROVED BY THE SUPERINTENDENT unless the corporation
 provides at least [sixty] THIRTY days advance [written]  notice  of  the
 [premium  rate  adjustment  approved  by the superintendent] ADJUSTMENT,
 EITHER THROUGH A POSTING ON ITS WEBSITE OR BY  WRITTEN  NOTICE  to  each
 contract holder and subscriber affected by the rate adjustment.
   § 3. This act shall take effect immediately.