STATE OF NEW YORK ________________________________________________________________________ 1039 2021-2022 Regular Sessions IN ASSEMBLY January 7, 2021 ___________ Introduced by M. of A. CAHILL, STIRPE, HEVESI, MAGNARELLI, ZEBROWSKI, STECK, QUART, FRIEND -- Multi-Sponsored by -- M. of A. FITZPATRICK -- 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- 23 ance, would be subject to this section. No insurer may provide stop 24 loss, catastrophic or reinsurance coverage to small groups which, if EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD01340-01-1A. 1039 2 1 they purchased insurance, would be subject to this section. Provided, 2 however, the provisions of this paragraph shall not apply to: (A) the 3 renewal of stop loss, catastrophic or reinsurance coverage issued and in 4 effect on January first, two thousand fifteen to small groups covering 5 between fifty-one and one hundred employees or members of the group; and 6 (B) the issuance between January first, two thousand sixteen and Decem- 7 ber thirty-first, two thousand sixteen, of stop loss, catastrophic or 8 reinsurance coverage, and any renewal thereof, to a small group covering 9 between fifty-one and one hundred employees or members of the group, 10 provided that such group had stop loss, catastrophic or reinsurance 11 coverage issued and in effect on January first, two thousand fifteen. 12 For purposes of this subsection, "small group" shall mean a group 13 comprised of between one and fifty employees or members, exclusive of 14 spouses and dependents. 15 § 3. Paragraph 1 of subsection (h) of section 3231 of the insurance 16 law, as added by chapter 501 of the laws of 1992, is amended to read as 17 follows: 18 (1) Notwithstanding any other provision of this chapter, no insurer, 19 subsidiary of an insurer, or controlled person of a holding company 20 system may act as an administrator or claims paying agent, as opposed to 21 an insurer, on behalf of small groups which, if they purchased insur- 22 ance, would be subject to this section. No insurer, subsidiary of an 23 insurer, or controlled person of a holding company may provide stop 24 loss, catastrophic or reinsurance coverage to small groups which, if 25 they purchased insurance, would be subject to this section. For purposes 26 of this subsection, "small group" shall mean a group comprised of 27 between one and fifty employees or members, exclusive of spouses and 28 dependents. 29 § 4. Paragraph 1 of subsection (a) of section 4317 of the insurance 30 law, as amended by section 72 of part D of chapter 56 of the laws of 31 2013, is amended to read as follows: 32 (1) No individual health insurance contract and no group health insur- 33 ance contract covering between one and fifty employees or members of the 34 group, except as set forth in subsection (e) of this section, or between 35 one and one hundred employees or members of the group for policies 36 issued or renewed on or after January first, two thousand sixteen exclu- 37 sive of spouses and dependents, including contracts for which the premi- 38 ums are paid by a remitting agent for a group, hereinafter referred to 39 as a small group, providing hospital and/or medical benefits, including 40 Medicare supplemental insurance, shall be issued in this state unless 41 such contract is community rated and, notwithstanding any other 42 provisions of law, the underwriting of such contract involves no more 43 than the imposition of a pre-existing condition limitation if otherwise 44 permitted by this article. 45 § 5. Paragraph 1 of subsection (e) of section 4317 of the insurance 46 law, as amended by chapter 12 of the laws of 2016, is amended to read as 47 follows: 48 (1) Notwithstanding any other provision of this chapter, no insurer, 49 subsidiary of an insurer, or controlled person of a holding company 50 system may act as an administrator or claims paying agent, as opposed to 51 an insurer, on behalf of small groups which, if they purchased insur- 52 ance, would be subject to this section. No insurer may provide stop 53 loss, catastrophic or reinsurance coverage to small groups which, if 54 they purchased insurance, would be subject to this section. Provided, 55 however, the provisions of this paragraph shall not apply to: (A) the 56 renewal of stop loss, catastrophic or reinsurance coverage issued and inA. 1039 3 1 effect on January first, two thousand fifteen to small groups covering 2 between fifty-one and one hundred employees or members of the group; and 3 (B) the issuance between January first, two thousand sixteen, and Decem- 4 ber thirty-first, two thousand sixteen, of stop loss, catastrophic or 5 reinsurance coverage, and any renewal thereof, to a small group covering 6 between fifty-one and one hundred employees or members of the group, 7 provided that such group had stop loss, catastrophic or reinsurance 8 coverage issued and in effect on January first, two thousand fifteen. 9 For purposes of this subsection, "small group" shall mean a group 10 comprised of between one and fifty employees or members, exclusive of 11 spouses and dependents. 12 § 6. Paragraph 1 of subsection (e) of section 4317 of the insurance 13 law, as amended by section 72 of part D of chapter 56 of the laws of 14 2013, is amended to read as follows: 15 (1) Notwithstanding any other provision of this chapter, no insurer, 16 subsidiary of an insurer, or controlled person of a holding company 17 system may act as an administrator or claims paying agent, as opposed to 18 an insurer, on behalf of small groups which, if they purchased insur- 19 ance, would be subject to this section. No insurer, subsidiary of an 20 insurer, or controlled person of a holding company may provide stop 21 loss, catastrophic or reinsurance coverage to small groups which, if 22 they purchased insurance, would be subject to this section. For 23 purposes of this subsection, "small group" shall mean a group comprised 24 of between one and fifty employees or members, exclusive of spouses and 25 dependents. 26 § 7. This act shall take effect immediately; provided, however the 27 amendments to paragraph 1 of subsection (h) of section 3231 of the 28 insurance law made by section two of this act shall be subject to the 29 expiration and reversion of such paragraph pursuant to section 5 of 30 chapter 588 of the laws of 2015, as amended, when upon such date the 31 provisions of section three of this act shall take effect; and provided, 32 further, the amendments to paragraph 1 of subsection (e) of section 4317 33 of the insurance law made by section five of this act shall be subject 34 to the expiration and reversion of such paragraph pursuant to section 5 35 of chapter 588 of the laws of 2015, as amended, when upon such date the 36 provisions of section six of this act shall take effect.