Bill Text: NY A00172 | 2019-2020 | General Assembly | Introduced

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Bill Title: Redefines "small group" for the purposes of certain provisions.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2020-01-08 - referred to insurance [A00172 Detail]

Download: New_York-2019-A00172-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                           172
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                       (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:
     1    Section 1. Paragraph 1 of subsection (a) of section 3231 of the insur-
     2  ance  law,  as amended by section 69 of part D of chapter 56 of the laws
     3  of 2013, is amended to read as follows:
     4    (1) No individual health insurance policy and no group  health  insur-
     5  ance  policy  covering between one and fifty employees or members of the
     6  group, except as set forth in subsection (h) of this section, or between
     7  one and one hundred employees or  members  of  the  group  for  policies
     8  issued or renewed on or after January first, two thousand sixteen exclu-
     9  sive  of  spouses  and  dependents,  hereinafter  referred to as a small
    10  group, providing hospital and/or medical  benefits,  including  medicare
    11  supplemental insurance, shall be issued in this state unless such policy
    12  is community rated and, notwithstanding any other provisions of law, the
    13  underwriting  of  such  policy involves no more than the imposition of a
    14  pre-existing condition limitation if otherwise permitted by  this  arti-
    15  cle.
    16    §  2.  Paragraph  1 of subsection (h) of section 3231 of the insurance
    17  law, as amended by chapter 12 of the laws of 2016, is amended to read as
    18  follows:
    19    (1) Notwithstanding any other provision of this chapter,  no  insurer,
    20  subsidiary  of  an  insurer,  or  controlled person of a holding company
    21  system may act as an administrator or claims paying agent, as opposed to
    22  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
     1  ance,  would  be  subject  to  this section. No insurer may provide stop
     2  loss, catastrophic or reinsurance coverage to  small  groups  which,  if
     3  they  purchased  insurance,  would be subject to this section. Provided,
     4  however,  the  provisions  of this paragraph shall not apply to: (A) the
     5  renewal of stop loss, catastrophic or reinsurance coverage issued and in
     6  effect on January first, two thousand fifteen to small  groups  covering
     7  between fifty-one and one hundred employees or members of the group; and
     8  (B)  the issuance between January first, two thousand sixteen and Decem-
     9  ber thirty-first, two thousand sixteen, of stop  loss,  catastrophic  or
    10  reinsurance coverage, and any renewal thereof, to a small group covering
    11  between  fifty-one  and  one  hundred employees or members of the group,
    12  provided that such group had  stop  loss,  catastrophic  or  reinsurance
    13  coverage  issued  and  in effect on January first, two thousand fifteen.
    14  For purposes of this  subsection,  "small  group"  shall  mean  a  group
    15  comprised  of  between  one and fifty employees or members, exclusive of
    16  spouses and dependents.
    17    § 3. Paragraph 1 of subsection (h) of section 3231  of  the  insurance
    18  law,  as added by chapter 501 of the laws of 1992, is amended to read as
    19  follows:
    20    (1) Notwithstanding any other provision of this chapter,  no  insurer,
    21  subsidiary  of  an  insurer,  or  controlled person of a holding company
    22  system may act as an administrator or claims paying agent, as opposed to
    23  an insurer, on behalf of small groups which, if  they  purchased  insur-
    24  ance,  would  be  subject  to this section. No insurer, subsidiary of an
    25  insurer, or controlled person of a  holding  company  may  provide  stop
    26  loss,  catastrophic  or  reinsurance  coverage to small groups which, if
    27  they purchased insurance, would be subject to this section. For purposes
    28  of this subsection, "small  group"  shall  mean  a  group  comprised  of
    29  between  one  and  fifty  employees or members, exclusive of spouses and
    30  dependents.
    31    § 4. Paragraph 1 of subsection (a) of section 4317  of  the  insurance
    32  law,  as  amended  by  section 72 of part D of chapter 56 of the laws of
    33  2013, is amended to read as follows:
    34    (1) No individual health insurance contract and no group health insur-
    35  ance contract covering between one and fifty employees or members of the
    36  group, except as set forth in subsection (e) of this section, or between
    37  one and one hundred employees or  members  of  the  group  for  policies
    38  issued or renewed on or after January first, two thousand sixteen exclu-
    39  sive of spouses and dependents, including contracts for which the premi-
    40  ums  are  paid by a remitting agent for a group, hereinafter referred to
    41  as a small group, providing hospital and/or medical benefits,  including
    42  Medicare  supplemental  insurance,  shall be issued in this state unless
    43  such  contract  is  community  rated  and,  notwithstanding  any   other
    44  provisions  of  law,  the underwriting of such contract involves no more
    45  than the imposition of a pre-existing condition limitation if  otherwise
    46  permitted by this article.
    47    §  5.  Paragraph  1 of subsection (e) of section 4317 of the insurance
    48  law, as amended by chapter 12 of the laws of 2016, is amended to read as
    49  follows:
    50    (1) Notwithstanding any other provision of this chapter,  no  insurer,
    51  subsidiary  of  an  insurer,  or  controlled person of a holding company
    52  system may act as an administrator or claims paying agent, as opposed to
    53  an insurer, on behalf of small groups which, if  they  purchased  insur-
    54  ance,  would  be  subject  to  this section. No insurer may provide stop
    55  loss, catastrophic or reinsurance coverage to  small  groups  which,  if
    56  they  purchased  insurance,  would be subject to this section. Provided,
        A. 172                              3
     1  however, the provisions of this paragraph shall not apply  to:  (A)  the
     2  renewal of stop loss, catastrophic or reinsurance coverage issued and in
     3  effect  on  January first, two thousand fifteen to small groups covering
     4  between fifty-one and one hundred employees or members of the group; and
     5  (B) the issuance between January first, two thousand sixteen, and Decem-
     6  ber  thirty-first,  two  thousand sixteen, of stop loss, catastrophic or
     7  reinsurance coverage, and any renewal thereof, to a small group covering
     8  between fifty-one and one hundred employees or  members  of  the  group,
     9  provided  that  such  group  had  stop loss, catastrophic or reinsurance
    10  coverage issued and in effect on January first,  two  thousand  fifteen.
    11  For  purposes  of  this  subsection,  "small  group"  shall mean a group
    12  comprised of between one and fifty employees or  members,  exclusive  of
    13  spouses and dependents.
    14    §  6.  Paragraph  1 of subsection (e) of section 4317 of the insurance
    15  law, as amended by section 72 of part D of chapter 56  of  the  laws  of
    16  2013, is amended to read as follows:
    17    (1)  Notwithstanding  any other provision of this chapter, no insurer,
    18  subsidiary of an insurer, or controlled  person  of  a  holding  company
    19  system may act as an administrator or claims paying agent, as opposed to
    20  an  insurer,  on  behalf of small groups which, if they purchased insur-
    21  ance, would be subject to this section. No  insurer,  subsidiary  of  an
    22  insurer,  or  controlled  person  of  a holding company may provide stop
    23  loss, catastrophic or reinsurance coverage to  small  groups  which,  if
    24  they  purchased  insurance,  would  be  subject  to  this section.   For
    25  purposes of this subsection, "small group" shall mean a group  comprised
    26  of  between one and fifty employees or members, exclusive of spouses and
    27  dependents.
    28    § 7. This act shall take effect  immediately;  provided,  however  the
    29  amendments  to  paragraph  1  of  subsection  (h) of section 3231 of the
    30  insurance law made by section two of this act shall be  subject  to  the
    31  expiration  and  reversion  of  such  paragraph pursuant to section 5 of
    32  chapter 588 of the laws of 2015, as amended, when  upon  such  date  the
    33  provisions of section three of this act shall take effect; and provided,
    34  further, the amendments to paragraph 1 of subsection (e) of section 4317
    35  of  the  insurance law made by section five of this act shall be subject
    36  to the expiration and reversion of such paragraph pursuant to section  5
    37  of  chapter 588 of the laws of 2015, as amended, when upon such date the
    38  provisions of section six of this act shall take effect.