Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
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Mar 04, 2024 |
referred to insurance delivered to assembly passed senate |
Jan 24, 2024 |
advanced to third reading |
Jan 23, 2024 |
2nd report cal. |
Jan 22, 2024 |
1st report cal.152 |
Jan 03, 2024 |
referred to insurance returned to senate died in assembly |
Mar 23, 2023 |
referred to insurance delivered to assembly passed senate |
Mar 16, 2023 |
advanced to third reading |
Mar 15, 2023 |
2nd report cal. |
Mar 13, 2023 |
1st report cal.480 |
Feb 08, 2023 |
referred to insurance |
Senate Bill S4435
2023-2024 Legislative Session
Authorizes health insurers to provide actuarially appropriate reductions in health insurance premiums for participation in a wellness program
download bill text pdfSponsored By
(D) 34th Senate District
Current Bill Status - In Assembly Committee
- Introduced
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- In Committee Assembly
- In Committee Senate
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- On Floor Calendar Assembly
- On Floor Calendar Senate
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- Passed Assembly
- Passed Senate
- Delivered to Governor
- Signed By Governor
Actions
Votes
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Floor Vote: Mar 4, 2024
aye (61)- Addabbo Jr.
- Ashby
- Bailey
- Borrello
- Breslin
- Brisport
- Canzoneri-Fitzpatrick
- Chu
- Cleare
- Comrie
- Cooney
- Felder
- Fernandez
- Gallivan
- Gianaris
- Gonzalez
- Gounardes
- Griffo
- Harckham
- Helming
- Hinchey
- Hoylman-Sigal
- Jackson
- Kavanagh
- Kennedy
- Krueger
- Lanza
- Liu
- Mannion
- Martinez
- Martins
- Mattera
- May
- Mayer
- Murray
- Myrie
- O'Mara
- Oberacker
- Ortt
- Palumbo
- Parker
- Persaud
- Ramos
- Rhoads
- Rivera
- Rolison
- Ryan
- Salazar
- Sanders Jr.
- Scarcella-Spanton
- Sepúlveda
- Serrano
- Skoufis
- Stavisky
- Stec
- Stewart-Cousins
- Tedisco
- Thomas
- Webb
- Weber
- Weik
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Floor Vote: Mar 23, 2023
aye (61)- Addabbo Jr.
- Ashby
- Bailey
- Borrello
- Breslin
- Brisport
- Brouk
- Chu
- Cleare
- Comrie
- Cooney
- Fernandez
- Gallivan
- Gianaris
- Gonzalez
- Gounardes
- Griffo
- Harckham
- Helming
- Hinchey
- Hoylman-Sigal
- Jackson
- Kavanagh
- Kennedy
- Krueger
- Lanza
- Liu
- Mannion
- Martinez
- Martins
- Mattera
- May
- Mayer
- Murray
- Myrie
- O'Mara
- Oberacker
- Ortt
- Palumbo
- Parker
- Persaud
- Ramos
- Rhoads
- Rivera
- Rolison
- Ryan
- Salazar
- Sanders Jr.
- Scarcella-Spanton
- Sepúlveda
- Serrano
- Skoufis
- Stavisky
- Stec
- Stewart-Cousins
- Tedisco
- Thomas
- Walczyk
- Webb
- Weber
- Weik
absent (1)excused (1)
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Jan 22, 2024 - Insurance Committee Vote
S443510Aye0Nay1Aye with Reservations0Absent0Excused0Abstained-
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Insurance Committee Vote: Jan 22, 2024
aye (10)aye wr (1)
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Mar 13, 2023 - Insurance Committee Vote
S443511Aye0Nay0Aye with Reservations0Absent0Excused0Abstained-
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Insurance Committee Vote: Mar 13, 2023
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co-Sponsors
(D, WF) 52nd Senate District
2023-S4435 (ACTIVE) - Details
2023-S4435 (ACTIVE) - Summary
Authorizes health insurers and health maintenance organizations, subject to the approval of the superintendent of financial services, to provide actuarially appropriate reductions in health insurance premiums or other benefits or enhancements for an enrollee's or insured's participation in a qualified wellness program.
2023-S4435 (ACTIVE) - Sponsor Memo
BILL NUMBER: S4435 SPONSOR: FERNANDEZ TITLE OF BILL: An act to amend the insurance law and the public health law, in relation to making actuarially appropriate reductions in health insurance premi- ums in return for an enrollee's or insured's participation in a quali- fied wellness program PURPOSE OR GENERAL IDEA OF BILL: To help curtail future health insurance premium increases, this bill clearly authorizes health insurers and health maintenance organizations (HMOs) to offer an actuarially appropriate Premium discount or other benefits or enhancements to covered persons that participate in a quali- fied wellness program. Such a program must be approved by the Super- intendent of the Financial Services Department. SUMMARY OF PROVISIONS: Section 1: Amends Insurance Law section 3231 to permit insurers and
HMOs that offer individual or small group insurance policies to offer an actuarially appropriate premium discount or other benefits or enhance- ments to those individuals that Participate in a qualified wellness program. Such qualified wellness program must be approved by the Finan- cial Services Department. Further, such qualified Wellness program can be either a risk management system that identifies at-risk populations or any other systematic program or course of medical conduct which helps to promote physical and mental fitness, helms to prevent or mitigate acute or chronic sickness, disease or Pain, or which minimizes adverse health consequences due to lifestyle. To protect all covered persons, the insurer or HMO shall not require specific medical outcomes as a result of an insured's adherence to the approved wellness program. Section 2: Amends insurance Law section 3239 which relates to Wellness Programs that can be sponsored by a health insurance plan. This provision expands the kinds of Wellness Programs that are covered under the Insurance Law to include substance or alcohol abuse cessation programs and programs to manage and cope with chronic pain. In addi- tion, the bill expands and provides for the full or partial reimburse- ment for the cost of participating in programs that are already current- ly authorized under this provision of the law, such as programs related to stress and or hypertension, worker injury prevention and nutrition education. Bill section 2 of this bill was recently amended such program could be contained in the policy or ancillary separate document and to add access to preventative care as one of the added benefits. Section 3: Amends Insurance Law section 4235(h) to permit insurers and HMOs that offer accident and health insurance (large group policies) to offer an actuarially appropriate premium discount or other benefits or enhancements to those persons that participate in a qualified wellness program approved by the Superintendent. Section 4: Amends Insurance Law section 4317 to permit Article 43 insurers and HMOs that offer individual or small group contracts to offer, subject to the approval of the Superintendent, an actuarially appropriate premium discount or other enhancements to those persons that participate in a qualified wellness program by adding subsection C-1. Section 5: Amends insurance Law section 4326 to permit insurers and HMOs that offer the subsidized "Healthy New York" policies to offer an actuarially appropriate premium discount or other enhancements to those persons that participate in a qualified wellness program. Section 6: Amends Public Health Law section 4405 to provide for the same actuarially appropriate reduction in HMO health policies for those who participate in a Qualified wellness program. Section 7: Sets forth the effective date JUSTIFICATION: Every year, health insurance rate payers are experiencing rapidly increasing premium rate increases. This increased cost of purchasing health insurance continues to force small and large businesses alike, to drop health insurance coverage for their employees and their families. This bill provides a new avenue to help keep health insurance rates low. Further, it encourages persons, via a financial incentive, to partic- ipate in qualified wellness programs to enhance their physical and mental fitness and well-being. We need to develop new and innovative ways to help to minimize future rate increases so that individuals will be able to afford the health care they need. Further, seducing or curtailing future health insurance premium increases will help to keep New York's businesses competitive with out of state firms. PRIOR LEGISLATIVE HISTORY: 2021-2022: S815 2019-2020: S4066 / A7472 2017-2018: S1783 2015-2016: S853 / A4238 2013-2014: S2331 / A5302 2011-2012: S4609/A8228 - Died in Insurance FISCAL IMPLICATIONS: None to the state EFFECTIVE DATE: This act shall take effect on the one hundred eightieth day after it shall have become a law. Effective immediately, the addition, amendment and/or repeal of any rule or regulation necessary for the implementation of this act on its effective date are authorized to be made and completed on or before such effective date.
2023-S4435 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 4435 2023-2024 Regular Sessions I N S E N A T E February 8, 2023 ___________ Introduced by Sen. FERNANDEZ -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law and the public health law, in relation to making actuarially appropriate reductions in health insurance premiums in return for an enrollee's or insured's participation in a qualified wellness program THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 3231 of the insurance law, as added by chapter 501 of the laws of 1992, is amended by adding a new subsection (c-1) to read as follows: (C-1) SUBJECT TO THE APPROVAL OF THE SUPERINTENDENT, AN INSURER OR HEALTH MAINTENANCE ORGANIZATION ISSUING AN INDIVIDUAL OR GROUP HEALTH INSURANCE POLICY PURSUANT TO THIS SECTION MAY PROVIDE FOR AN ACTUARIALLY APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S OR INSURED'S ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELL- NESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BE- ING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINIMIZES ADVERSE HEALTH CONSE- QUENCES DUE TO LIFESTYLE. SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS: (1) AN EDUCATION PROGRAM TO INCREASE THE AWARENESS OF AND DISSEM- INATION OF INFORMATION ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH WARNS ABOUT RISKS OF PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI- EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD08825-01-3 S. 4435 2
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER- TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS; (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR- AGE HEALTHY LIVING ACTIVITIES OR DISCOURAGE UNHEALTHY LIVING ACTIVITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE WELLNESS PROGRAMS, AS PROVIDED UNDER SECTION THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS ARTICLE; AND (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM. SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES THE GENERAL GOOD HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A RESULT OF AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM. § 2. Subsections (a), (b) and (c) of section 3239 of the insurance law, subsection (a) as added by chapter 592 of the laws of 2008, and subsections (b) and (c) as amended by chapter 180 of the laws of 2016, are amended to read as follows: (a) An insurer licensed to write accident and health insurance, a corporation organized pursuant to article forty-three of this chapter, a health maintenance organization certified pursuant to article forty-four of the public health law and a municipal cooperative health benefits plan may establish a wellness program in conjunction with its issuance of a group accident and health insurance policy or group subscriber contract. A "wellness program" is a program designed to promote health and prevent disease that may contain rewards and incentives for partic- ipation. Participation in the wellness program shall be available to similarly-situated members of the group and shall be voluntary on the part of the member. The SPECIFIC terms of the wellness program shall be set forth in the policy or contract, OR IN A SEPARATE DOCUMENT PROVIDED TO INSUREDS AND MEMBERS WHICH SHALL BE CONSISTENT WITH THE PROVISIONS OF THIS SECTION. (b) A wellness program may include, but is not limited to, the follow- ing programs or services: (1) the use of a health risk assessment tool; (2) a smoking cessation program; (3) a weight management program; (4) a stress and/or hypertension management program; (5) a worker injury prevention program; (6) a nutrition education program; (7) health or fitness incentive programs; (8) a coordinated weight management, nutrition, stress management and physical fitness program to combat the high incidence of adult and childhood obesity, asthma and other chronic respiratory conditions; (9) a substance or alcohol abuse cessation program; [and] (10) a program to manage and cope with chronic pain[.] ; (11) ASSISTANCE, FINANCIAL OR OTHERWISE, PROVIDED TO AN EMPLOYER FOR HEALTH PROMOTION AND DISEASE PREVENTION; AND (12) INCENTIVES FOR INSUREDS OR MEMBERS TO ACCESS PREVENTIVE SERVICES, SUCH AS MAMMOGRAPHY SCREENING. (c)(1) A wellness program may use rewards and incentives for partic- ipation provided that where the group health insurance policy or subscriber contract is required to be community-rated, the rewards and incentives shall not include a discounted premium rate or a rebate or S. 4435 3 refund of premium, EXCEPT AS PROVIDED IN SECTION THREE THOUSAND TWO HUNDRED THIRTY-ONE OF THIS ARTICLE, OR SECTION FOUR THOUSAND TWO HUNDRED THIRTY-FIVE, FOUR THOUSAND THREE HUNDRED SEVENTEEN OR FOUR THOUSAND THREE HUNDRED TWENTY-SIX OF THIS CHAPTER, OR SECTION FORTY-FOUR HUNDRED FIVE OF THE PUBLIC HEALTH LAW. (2) Permissible rewards and incentives may include: (A) full or partial reimbursement of the cost of participating in smoking cessation, weight management, stress and/or hypertension, worker injury prevention, nutrition education, substance or alcohol abuse cessation, or chronic pain management and coping programs; (B) full or partial reimbursement of the cost of membership in a health club or fitness center; (C) the waiver or reduction of copayments, coinsurance and deductibles for preventive services covered under the group policy or subscriber contract; (D) monetary rewards in the form of gift cards or gift certificates, so long as the recipient of the reward is encouraged to use the reward for a product or a service that promotes good health, such as healthy cook books, over the counter vitamins or exercise equipment; (E) full or partial reimbursement of the cost of participating in a stress management program or activity; and (F) full or partial reimbursement of the cost of participating in a health or fitness program. (3) Where the reward involves a group member's meeting a specified standard based on a health condition, the wellness program must meet the requirements of 45 CFR Part 146. (4) A reward or incentive which involves a discounted premium rate or a rebate or refund of premium shall be based on actuarial demonstration that the wellness program can reasonably be expected to result in the overall good health and well being of the group AS PROVIDED IN SECTION THREE THOUSAND TWO HUNDRED THIRTY-ONE OF THIS ARTICLE, SECTIONS FOUR THOUSAND TWO HUNDRED THIRTY-FIVE, FOUR THOUSAND THREE HUNDRED SEVENTEEN AND FOUR THOUSAND THREE HUNDRED TWENTY-SIX OF THIS CHAPTER, AND SECTION FORTY-FOUR HUNDRED FIVE OF THE PUBLIC HEALTH LAW. § 3. Subsection (h) of section 4235 of the insurance law is amended by adding a new paragraph 5 to read as follows: (5) EACH INSURER DOING BUSINESS IN THIS STATE, WHEN FILING WITH THE SUPERINTENDENT ITS SCHEDULES OF PREMIUM RATES, RULES AND CLASSIFICATION OF RISKS FOR USE IN CONNECTION WITH THE ISSUANCE OF ITS POLICIES OF GROUP ACCIDENT, GROUP HEALTH OR GROUP ACCIDENT AND HEALTH INSURANCE, MAY PROVIDE FOR AN ACTUARIALLY APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOUR- AGE AN ENROLLEE'S OR INSURED'S ACTIVE PARTICIPATION IN A QUALIFIED WELL- NESS PROGRAM. A QUALIFIED WELLNESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINI- MIZES ADVERSE HEALTH CONSEQUENCES DUE TO LIFESTYLE. SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS: (A) AN EDUCATION PROGRAM TO INCREASE THE AWARENESS OF AND DISSEM- INATION OF INFORMATION ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH WARNS ABOUT RISKS OF PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI- S. 4435 4 CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER- TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS; (B) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR- AGE HEALTHY LIVING ACTIVITIES OR DISCOURAGE UNHEALTHY LIVING ACTIVITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE WELLNESS PROGRAMS, AS PROVIDED UNDER SECTION THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS CHAPTER; (C) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM. SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES THE GENERAL GOOD HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A RESULT OF AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM. § 4. Section 4317 of the insurance law is amended by adding a new subsection (c-1) to read as follows: (C-1) SUBJECT TO THE APPROVAL OF THE SUPERINTENDENT, AN INSURER OR HEALTH MAINTENANCE ORGANIZATION ISSUING AN INDIVIDUAL OR GROUP HEALTH INSURANCE CONTRACT PURSUANT TO THIS SECTION MAY PROVIDE FOR AN ACTUARI- ALLY APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S OR INSURED'S ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELLNESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT IDENTI- FIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINIMIZES ADVERSE HEALTH CONSEQUENCES DUE TO LIFESTYLE. SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS: (1) AN EDUCATION PROGRAM TO INCREASE THE AWARENESS OF AND DISSEM- INATION OF INFORMATION ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH WARNS ABOUT RISKS OF PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI- CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER- TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS; (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR- AGE HEALTHY LIVING ACTIVITIES OR DISCOURAGE UNHEALTHY LIVING ACTIVITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE WELLNESS PROGRAMS, AS PROVIDED UNDER SECTION THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS CHAPTER; AND (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM. SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES THE GENERAL GOOD HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A RESULT OF AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM. § 5. Subsection (m) of section 4326 of the insurance law is amended by adding a new paragraph 4 to read as follows: (4) APPROVAL OF THE SUPERINTENDENT, AN INSURER OR HEALTH MAINTENANCE ORGANIZATION ISSUING A CONTRACT FOR QUALIFYING SMALL EMPLOYERS OR INDI- S. 4435 5 VIDUALS PURSUANT TO THIS SECTION MAY PROVIDE FOR AN ACTUARIALLY APPRO- PRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S OR INSURED'S ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELL- NESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BE- ING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINIMIZES ADVERSE HEALTH CONSE- QUENCES DUE TO LIFESTYLE. SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS: (A) AN EDUCATION PROGRAM TO INCREASE THE AWARENESS OF AND DISSEM- INATION OF INFORMATION ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH WARNS ABOUT RISKS OF PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI- CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER- TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS; (B) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR- AGE HEALTHY LIVING ACTIVITIES OR DISCOURAGE UNHEALTHY LIVING ACTIVITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE WELLNESS PROGRAMS, AS PROVIDED UNDER SECTION THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS CHAPTER; AND (C) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM. SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES THE GENERAL GOOD HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A RESULT OF AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM. § 6. Section 4405 of the public health law is amended by adding a new subdivision 5-a to read as follows: 5-A. SUBJECT TO THE APPROVAL OF THE SUPERINTENDENT OF FINANCIAL SERVICES, THE POSSIBLE PROVIDING OF AN ACTUARIALLY APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT OF FINANCIAL SERVICES TO ENCOURAGE AN ENROLLEE'S ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELLNESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK POPU- LATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BE- ING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINIMIZES ADVERSE HEALTH CONSE- QUENCES DUE TO LIFESTYLE. SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS: (1) AN EDUCATION PROGRAM TO INCREASE THE AWARENESS OF AND DISSEM- INATION OF INFORMATION ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH WARNS ABOUT RISKS OF PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI- CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER- TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS; S. 4435 6 (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR- AGE HEALTHY LIVING ACTIVITIES OR DISCOURAGE UNHEALTHY LIVING ACTIVITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE WELLNESS PROGRAMS, AS PROVIDED UNDER SECTION THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THE INSURANCE LAW; AND (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM. SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES THE GENERAL GOOD HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A RESULT OF AN ENROLLEE'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM; § 7. This act shall take effect on the one hundred eightieth day after it shall have become a law. Effective immediately, the addition, amend- ment and/or repeal of any rule or regulation necessary for the implemen- tation of this act on its effective date are authorized to be made and completed on or before such effective date.
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