Bill Text: NY A07472 | 2019-2020 | General Assembly | Introduced
Bill Title: 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.
Spectrum: Moderate Partisan Bill (Democrat 28-4)
Status: (Introduced - Dead) 2020-01-08 - referred to insurance [A07472 Detail]
Download: New_York-2019-A07472-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7472 2019-2020 Regular Sessions IN ASSEMBLY May 6, 2019 ___________ Introduced by M. of A. GOTTFRIED, ARROYO, BLAKE, BUTTENSCHON, COLTON, COOK, CROUCH, CRUZ, DICKENS, DINOWITZ, FALL, GALEF, JEAN-PIERRE, LUPARDO, MOSLEY, OTIS, SALKA, SAYEGH, SIMON, STIRPE, THIELE -- Multi- Sponsored by -- M. of A. LAWRENCE, LENTOL -- read once and referred 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: 1 Section 1. Section 3231 of the insurance law, as added by chapter 501 2 of the laws of 1992, is amended by adding a new subsection (c-1) to read 3 as follows: 4 (c-1) Subject to the approval of the superintendent, an insurer or 5 health maintenance organization issuing an individual or group health 6 insurance policy pursuant to this section may provide for an actuarially 7 appropriate reduction in premium rates or other benefits or enhancements 8 approved by the superintendent to encourage an enrollee's or insured's 9 active participation in a qualified wellness program. A qualified well- 10 ness program can be a risk management system that identifies at-risk 11 populations or any other systematic program or course of medical conduct 12 which helps to promote physical and mental fitness, health and well-be- 13 ing, helps to prevent or mitigate the conditions of acute or chronic 14 sickness, disease or pain, or which minimizes adverse health conse- 15 quences due to lifestyle. Such a wellness program may have some or all 16 of the following elements to advance the physical health and mental 17 well-being of its participants: 18 (1) an education program to increase the awareness of and dissem- 19 ination of information about pursuing healthier lifestyles, and which 20 warns about risks of pursuing environmental or behavioral activities EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD09863-01-9A. 7472 2 1 that are detrimental to human health. In addition, information on the 2 availability of health screening tests to assist in the early identifi- 3 cation and treatment of diseases such as cancer, heart disease, hyper- 4 tension, diabetes, asthma, obesity or other adverse health afflictions; 5 (2) a program that encourages behavioral practices that either encour- 6 age healthy living activities or discourage unhealthy living activities. 7 Such activities or practices may include wellness programs, as provided 8 under section three thousand two hundred thirty-nine of this article; 9 and 10 (3) the monitoring of the progress of each covered person to track his 11 or her adherence to such wellness program and to provide assistance and 12 moral support to such covered person to assist him or her to attain the 13 goals of the covered person's wellness program. 14 Such wellness program shall demonstrate actuarially that it encourages 15 the general good health and well-being of the covered population. The 16 insurer or health maintenance organization shall not require specific 17 outcomes as a result of an enrollee's or insured's adherence to the 18 approved wellness program. 19 § 2. Subsections (a), (b) and (c) of section 3239 of the insurance 20 law, subsection (a) as added by chapter 592 of the laws of 2008, and 21 subsections (b) and (c) as amended by chapter 180 of the laws of 2016, 22 are amended to read as follows: 23 (a) An insurer licensed to write accident and health insurance, a 24 corporation organized pursuant to article forty-three of this chapter, a 25 health maintenance organization certified pursuant to article forty-four 26 of the public health law and a municipal cooperative health benefits 27 plan may establish a wellness program in conjunction with its issuance 28 of a group accident and health insurance policy or group subscriber 29 contract. A "wellness program" is a program designed to promote health 30 and prevent disease that may contain rewards and incentives for partic- 31 ipation. Participation in the wellness program shall be available to 32 similarly-situated members of the group and shall be voluntary on the 33 part of the member. The specific terms of the wellness program shall be 34 set forth in the policy or contract, or in a separate document provided 35 to insureds and members which shall be consistent with the provisions of 36 this section. 37 (b) A wellness program may include, but is not limited to, the follow- 38 ing programs or services: 39 (1) the use of a health risk assessment tool; 40 (2) a smoking cessation program; 41 (3) a weight management program; 42 (4) a stress and/or hypertension management program; 43 (5) a worker injury prevention program; 44 (6) a nutrition education program; 45 (7) health or fitness incentive programs; 46 (8) a coordinated weight management, nutrition, stress management and 47 physical fitness program to combat the high incidence of adult and 48 childhood obesity, asthma and other chronic respiratory conditions; 49 (9) a substance or alcohol abuse cessation program; [and] 50 (10) a program to manage and cope with chronic pain[.] ; 51 (11) assistance, financial or otherwise, provided to an employer for 52 health promotion and disease prevention; and 53 (12) incentives for insureds or members to access preventive services, 54 such as mammography screening. 55 (c)(1) A wellness program may use rewards and incentives for partic- 56 ipation provided that where the group health insurance policy orA. 7472 3 1 subscriber contract is required to be community-rated, the rewards and 2 incentives shall not include a discounted premium rate or a rebate or 3 refund of premium, except as provided in section three thousand two 4 hundred thirty-one of this article, or section four thousand two hundred 5 thirty-five, four thousand three hundred seventeen or four thousand 6 three hundred twenty-six of this chapter, or section forty-four hundred 7 five of the public health law. 8 (2) Permissible rewards and incentives may include: 9 (A) full or partial reimbursement of the cost of participating in 10 smoking cessation, weight management, stress and/or hypertension, worker 11 injury prevention, nutrition education, substance or alcohol abuse 12 cessation, or chronic pain management and coping programs; 13 (B) full or partial reimbursement of the cost of membership in a 14 health club or fitness center; 15 (C) the waiver or reduction of copayments, coinsurance and deductibles 16 for preventive services covered under the group policy or subscriber 17 contract; 18 (D) monetary rewards in the form of gift cards or gift certificates, 19 so long as the recipient of the reward is encouraged to use the reward 20 for a product or a service that promotes good health, such as healthy 21 cook books, over the counter vitamins or exercise equipment; 22 (E) full or partial reimbursement of the cost of participating in a 23 stress management program or activity; and 24 (F) full or partial reimbursement of the cost of participating in a 25 health or fitness program. 26 (3) Where the reward involves a group member's meeting a specified 27 standard based on a health condition, the wellness program must meet the 28 requirements of 45 CFR Part 146. 29 (4) A reward or incentive which involves a discounted premium rate or 30 a rebate or refund of premium shall be based on actuarial demonstration 31 that the wellness program can reasonably be expected to result in the 32 overall good health and well being of the group as provided in section 33 three thousand two hundred thirty-one of this article, sections four 34 thousand two hundred thirty-five, four thousand three hundred seventeen 35 and four thousand three hundred twenty-six of this chapter, and section 36 forty-four hundred five of the public health law. 37 § 3. Subsection (h) of section 4235 of the insurance law is amended by 38 adding a new paragraph 5 to read as follows: 39 (5) Each insurer doing business in this state, when filing with the 40 superintendent its schedules of premium rates, rules and classification 41 of risks for use in connection with the issuance of its policies of 42 group accident, group health or group accident and health insurance, may 43 provide for an actuarially appropriate reduction in premium rates or 44 other benefits or enhancements approved by the superintendent to encour- 45 age an enrollee's or insured's active participation in a qualified well- 46 ness program. A qualified wellness program can be a risk management 47 system that identifies at-risk populations or any other systematic 48 program or course of medical conduct which helps to promote physical and 49 mental fitness, health and well-being, helps to prevent or mitigate the 50 conditions of acute or chronic sickness, disease or pain, or which mini- 51 mizes adverse health consequences due to lifestyle. Such a wellness 52 program may have some or all of the following elements to advance the 53 physical health and mental well-being of its participants: 54 (A) an education program to increase the awareness of and dissem- 55 ination of information about pursuing healthier lifestyles, and which 56 warns about risks of pursuing environmental or behavioral activitiesA. 7472 4 1 that are detrimental to human health. In addition, information on the 2 availability of health screening tests to assist in the early identifi- 3 cation and treatment of diseases such as cancer, heart disease, hyper- 4 tension, diabetes, asthma, obesity or other adverse health afflictions; 5 (B) a program that encourages behavioral practices that either encour- 6 age healthy living activities or discourage unhealthy living activities. 7 Such activities or practices may include wellness programs, as provided 8 under section three thousand two hundred thirty-nine of this chapter; 9 (C) the monitoring of the progress of each covered person to track his 10 or her adherence to such wellness program and to provide assistance and 11 moral support to such covered person to assist him or her to attain the 12 goals of the covered person's wellness program. 13 Such wellness program shall demonstrate actuarially that it encourages 14 the general good health and well-being of the covered population. The 15 insurer or health maintenance organization shall not require specific 16 outcomes as a result of an enrollee's or insured's adherence to the 17 approved wellness program. 18 § 4. Section 4317 of the insurance law is amended by adding a new 19 subsection (c-1) to read as follows: 20 (c-1) Subject to the approval of the superintendent, an insurer or 21 health maintenance organization issuing an individual or group health 22 insurance contract pursuant to this section may provide for an actuari- 23 ally appropriate reduction in premium rates or other benefits or 24 enhancements approved by the superintendent to encourage an enrollee's 25 or insured's active participation in a qualified wellness program. A 26 qualified wellness program can be a risk management system that identi- 27 fies at-risk populations or any other systematic program or course of 28 medical conduct which helps to promote physical and mental fitness, 29 health and well-being, helps to prevent or mitigate the conditions of 30 acute or chronic sickness, disease or pain, or which minimizes adverse 31 health consequences due to lifestyle. Such a wellness program may have 32 some or all of the following elements to advance the physical health and 33 mental well-being of its participants: 34 (1) an education program to increase the awareness of and dissem- 35 ination of information about pursuing healthier lifestyles, and which 36 warns about risks of pursuing environmental or behavioral activities 37 that are detrimental to human health. In addition, information on the 38 availability of health screening tests to assist in the early identifi- 39 cation and treatment of diseases such as cancer, heart disease, hyper- 40 tension, diabetes, asthma, obesity or other adverse health afflictions; 41 (2) a program that encourages behavioral practices that either encour- 42 age healthy living activities or discourage unhealthy living activities. 43 Such activities or practices may include wellness programs, as provided 44 under section three thousand two hundred thirty-nine of this chapter; 45 and 46 (3) the monitoring of the progress of each covered person to track his 47 or her adherence to such wellness program and to provide assistance and 48 moral support to such covered person to assist him or her to attain the 49 goals of the covered person's wellness program. 50 Such wellness program shall demonstrate actuarially that it encourages 51 the general good health and well-being of the covered population. The 52 insurer or health maintenance organization shall not require specific 53 outcomes as a result of an enrollee's or insured's adherence to the 54 approved wellness program. 55 § 5. Subsection (m) of section 4326 of the insurance law is amended by 56 adding a new paragraph 4 to read as follows:A. 7472 5 1 (4) approval of the superintendent, an insurer or health maintenance 2 organization issuing a contract for qualifying small employers or indi- 3 viduals pursuant to this section may provide for an actuarially appro- 4 priate reduction in premium rates or other benefits or enhancements 5 approved by the superintendent to encourage an enrollee's or insured's 6 active participation in a qualified wellness program. A qualified well- 7 ness program can be a risk management system that identifies at-risk 8 populations or any other systematic program or course of medical conduct 9 which helps to promote physical and mental fitness, health and well-be- 10 ing, helps to prevent or mitigate the conditions of acute or chronic 11 sickness, disease or pain, or which minimizes adverse health conse- 12 quences due to lifestyle. Such a wellness program may have some or all 13 of the following elements to advance the physical health and mental 14 well-being of its participants: 15 (A) an education program to increase the awareness of and dissem- 16 ination of information about pursuing healthier lifestyles, and which 17 warns about risks of pursuing environmental or behavioral activities 18 that are detrimental to human health. In addition, information on the 19 availability of health screening tests to assist in the early identifi- 20 cation and treatment of diseases such as cancer, heart disease, hyper- 21 tension, diabetes, asthma, obesity or other adverse health afflictions; 22 (B) a program that encourages behavioral practices that either encour- 23 age healthy living activities or discourage unhealthy living activities. 24 Such activities or practices may include wellness programs, as provided 25 under section three thousand two hundred thirty-nine of this chapter; 26 and 27 (C) the monitoring of the progress of each covered person to track his 28 or her adherence to such wellness program and to provide assistance and 29 moral support to such covered person to assist him or her to attain the 30 goals of the covered person's wellness program. 31 Such wellness program shall demonstrate actuarially that it encourages 32 the general good health and well-being of the covered population. The 33 insurer or health maintenance organization shall not require specific 34 outcomes as a result of an enrollee's or insured's adherence to the 35 approved wellness program. 36 § 6. Section 4405 of the public health law is amended by adding a new 37 subdivision 5-a to read as follows: 38 5-a. subject to the approval of the superintendent of financial 39 services, the possible providing of an actuarially appropriate reduction 40 in premium rates or other benefits or enhancements approved by the 41 superintendent of financial services to encourage an enrollee's active 42 participation in a qualified wellness program. A qualified wellness 43 program can be a risk management system that identifies at-risk popu- 44 lations or any other systematic program or course of medical conduct 45 which helps to promote physical and mental fitness, health and well-be- 46 ing, helps to prevent or mitigate the conditions of acute or chronic 47 sickness, disease or pain, or which minimizes adverse health conse- 48 quences due to lifestyle. Such a wellness program may have some or all 49 of the following elements to advance the physical health and mental 50 well-being of its participants: 51 (1) an education program to increase the awareness of and dissem- 52 ination of information about pursuing healthier lifestyles, and which 53 warns about risks of pursuing environmental or behavioral activities 54 that are detrimental to human health. In addition, information on the 55 availability of health screening tests to assist in the early identifi-A. 7472 6 1 cation and treatment of diseases such as cancer, heart disease, hyper- 2 tension, diabetes, asthma, obesity or other adverse health afflictions; 3 (2) a program that encourages behavioral practices that either encour- 4 age healthy living activities or discourage unhealthy living activities. 5 Such activities or practices may include wellness programs, as provided 6 under section three thousand two hundred thirty-nine of the insurance 7 law; and 8 (3) the monitoring of the progress of each covered person to track his 9 or her adherence to such wellness program and to provide assistance and 10 moral support to such covered person to assist him or her to attain the 11 goals of the covered person's wellness program. 12 Such wellness program shall demonstrate actuarially that it encourages 13 the general good health and well-being of the covered population. The 14 health maintenance organization shall not require specific outcomes as a 15 result of an enrollee's adherence to the approved wellness program; 16 § 7. This act shall take effect on the one hundred eightieth day after 17 it shall have become a law. Effective immediately, the addition, amend- 18 ment and/or repeal of any rule or regulation necessary for the implemen- 19 tation of this act on its effective date are authorized to be made and 20 completed on or before such effective date.