Bill Text: NY A07077 | 2017-2018 | General Assembly | Introduced

New York Assembly Bill 7077 (Prior Session Legislation)

Introduced

Bill Title: Amends the definition of "small group" for purposes of health insurance policies and contracts to fifty employees or fewer; and repeals provisions requiring the superintendent to conduct an impact study.

Spectrum: Moderate Partisan Bill (Democrat 11-3)

Status: (Introduced - Dead) 2018-01-03 - referred to insurance [A07077 Detail]

Download: New_York-2017-A07077-Introduced.html

                STATE OF NEW YORK
        ________________________________________________________________________
                                          7077
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                      April 4, 2017
                                       ___________
        Introduced by M. of A. CRESPO -- read once and referred to the Committee
          on Insurance
        AN  ACT  to  amend  the  insurance law, in relation to the definition of
          small group; and to repeal section 7 of chapter 12 of the laws of 2016
          relating to directing the  superintendent  of  financial  services  to
          contract with an independent entity to conduct an assessment regarding
          the  impact  of the prohibition on the sale of stop loss, catastrophic
          and reinsurance coverage to the small group market relating thereto
          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 [or between one and one hundred employees or members of the  group
     7  for  policies  issued or renewed on or after January first, two thousand
     8  sixteen] exclusive of spouses and dependents, hereinafter referred to as
     9  a small group, providing hospital  and/or  medical  benefits,  including
    10  medicare  supplemental  insurance,  shall be issued in this state unless
    11  such policy is community rated and, notwithstanding any other provisions
    12  of law, the underwriting of such policy involves no more than the  impo-
    13  sition  of a pre-existing condition limitation if otherwise permitted by
    14  this article.
    15    § 2. Paragraph 3 of subsection (a) of section 3231  of  the  insurance
    16  law,  as  amended  by  section 69 of part D of chapter 56 of the laws of
    17  2013, is amended to read as follows:
    18    (3) Once accepted for coverage, an individual or small group cannot be
    19  terminated by the insurer due to claims experience.   Termination of  an
    20  individual  or  small  group  shall  be based only on one or more of the
    21  reasons set forth in  subsection  (g)  of  section  three  thousand  two
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04876-01-7

        A. 7077                             2
     1  hundred  sixteen or subsection (p) of section three thousand two hundred
     2  twenty-one of this article.  Group  hospital  and/or  medical  coverage,
     3  including  medicare  supplemental insurance, obtained through an out-of-
     4  state  trust  covering  a group of fifty or fewer employees, [or between
     5  one and one hundred employees for policies issued or renewed on or after
     6  January first, two thousand sixteen,] or participating persons  who  are
     7  residents  of this state must be community rated regardless of the situs
     8  of delivery of the policy. Notwithstanding any other provisions of  law,
     9  the  underwriting of such policy may involve no more than the imposition
    10  of a pre-existing condition limitation if permitted by this article, and
    11  once accepted for coverage, an  individual  or  small  group  cannot  be
    12  terminated  due  to  claims  experience. Termination of an individual or
    13  small group shall be based only on one or more of the reasons set  forth
    14  in  subsection  (p)  of section three thousand two hundred twenty-one of
    15  this article.
    16    § 3. 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
    25  they purchased insurance, would be subject to this  section.  [Provided,
    26  however,  the  provisions  of this paragraph shall not apply to: (A) the
    27  renewal of stop loss, catastrophic or reinsurance coverage issued and in
    28  effect on January first, two thousand fifteen to small  groups  covering
    29  between fifty-one and one hundred employees or members of the group; and
    30  (B)  the issuance between January first, two thousand sixteen and Decem-
    31  ber thirty-first, two thousand sixteen, of stop  loss,  catastrophic  or
    32  reinsurance coverage, and any renewal thereof, to a small group covering
    33  between  fifty-one  and  one  hundred employees or members of the group,
    34  provided that such group had  stop  loss,  catastrophic  or  reinsurance
    35  coverage issued and in effect on January first, two thousand fifteen.]
    36    §  4.  Paragraph  1 of subsection (a) of section 4317 of the insurance
    37  law, as amended by section 72 of part D of chapter 56  of  the  laws  of
    38  2013, is amended to read as follows:
    39    (1) No individual health insurance contract and no group health insur-
    40  ance contract covering between one and fifty employees or members of the
    41  group, [or between one and one hundred employees or members of the group
    42  for  policies  issued or renewed on or after January first, two thousand
    43  sixteen] exclusive of spouses and dependents,  including  contracts  for
    44  which the premiums are paid by a remitting agent for a group, hereinaft-
    45  er referred to as a small group, providing hospital and/or medical bene-
    46  fits, including Medicare supplemental insurance, shall be issued in this
    47  state  unless  such contract is community rated and, notwithstanding any
    48  other provisions of law, the underwriting of such contract  involves  no
    49  more  than  the  imposition  of  a  pre-existing condition limitation if
    50  otherwise permitted by this article.
    51    § 5. Paragraph 1 of subsection (e) of section 4317  of  the  insurance
    52  law, as amended by chapter 12 of the laws of 2016, is amended to read as
    53  follows:
    54    (1)  Notwithstanding  any other provision of this chapter, no insurer,
    55  subsidiary of an insurer, or controlled  person  of  a  holding  company
    56  system may act as an administrator or claims paying agent, as opposed to

        A. 7077                             3
     1  an  insurer,  on  behalf of small groups which, if they purchased insur-
     2  ance, would be subject to this section.  No  insurer  may  provide  stop
     3  loss,  catastrophic  or  reinsurance  coverage to small groups which, if
     4  they  purchased  insurance, would be subject to this section. [Provided,
     5  however, the provisions of this paragraph shall not apply  to:  (A)  the
     6  renewal of stop loss, catastrophic or reinsurance coverage issued and in
     7  effect  on  January first, two thousand fifteen to small groups covering
     8  between fifty-one and one hundred employees or members of the group; and
     9  (B) the issuance between January first, two thousand sixteen, and Decem-
    10  ber thirty-first, two thousand sixteen, of stop  loss,  catastrophic  or
    11  reinsurance coverage, and any renewal thereof, to a small group covering
    12  between  fifty-one  and  one  hundred employees or members of the group,
    13  provided that such group had  stop  loss,  catastrophic  or  reinsurance
    14  coverage issued and in effect on January first, two thousand fifteen.]
    15    §  6.  Paragraph  1 of subsection (g) of section 3231 of the insurance
    16  law, as amended by chapter 12 of the laws of 2016, is amended to read as
    17  follows:
    18    (1) [(A)] This section shall also apply to policies issued to a  group
    19  defined  in  subsection (c) of section four thousand two hundred thirty-
    20  five of this chapter, including but not limited  to  an  association  or
    21  trust  of  employers, if the group includes one or more member employers
    22  or other member groups having [one hundred] fifty or fewer employees  or
    23  members  exclusive  of  spouses  and  dependents. For a policy issued or
    24  renewed on or after January first, two thousand fourteen, if  the  group
    25  includes  one or more member small group employers eligible for coverage
    26  subject to this section, then such member employers shall be  classified
    27  as  small  groups for rating purposes and the remaining members shall be
    28  rated consistent with the rating  rules  applicable  to  such  remaining
    29  members  pursuant to paragraph two of this subsection. [(B) Subparagraph
    30  A of this paragraph shall not apply to either the renewal  of  a  policy
    31  issued  to  a group or the issuance, between January first, two thousand
    32  sixteen and December thirty-first, two thousand sixteen,  of  a  policy,
    33  and  any  renewal thereof, to a group, provided that the following three
    34  requirements are met: (I) the group had been issued a policy that was in
    35  effect on July first, two thousand fifteen; (II) the  group  had  member
    36  employers,  who,  on  or  after  July  first, two thousand fifteen, have
    37  between fifty-one and one hundred employees, exclusive  of  spouses  and
    38  dependents; and (III) the group is either: (i) comprised entirely of one
    39  or  more  municipal corporations or districts (as such terms are defined
    40  in section one hundred nineteen-n of the general municipal law); or (ii)
    41  comprised entirely of nonpublic schools providing education in any grade
    42  from pre-kindergarten through twelfth grade.]
    43    § 7. Paragraph 1 of subsection (d) of section 4317  of  the  insurance
    44  law, as amended by chapter 12 of the laws of 2016, is amended to read as
    45  follows:
    46    (1)  [(A)]  This  section  shall  also apply to a contract issued to a
    47  group defined in subsection (c) of section  four  thousand  two  hundred
    48  thirty-five of this chapter, including but not limited to an association
    49  or  trust of employers, if the group includes one or more member employ-
    50  ers or other member groups having [one hundred] fifty or fewer employees
    51  or members exclusive of spouses and dependents. For a contract issued or
    52  renewed on or after January first, two thousand fourteen, if  the  group
    53  includes  one or more member small group employers eligible for coverage
    54  subject to this section, then such member employers shall be  classified
    55  as  small  groups for rating purposes and the remaining members shall be
    56  rated consistent with the rating  rules  applicable  to  such  remaining

        A. 7077                             4
     1  members  pursuant to paragraph two of this subsection. [(B) Subparagraph
     2  A of this paragraph shall not apply to either the renewal of a  contract
     3  issued  to  a group or the issuance, between January first, two thousand
     4  sixteen  and December thirty-first, two thousand sixteen, of a contract,
     5  and any renewal thereof, to a group, provided that the  following  three
     6  requirements  are met: (I) the group had been issued a contract that was
     7  in effect on July first, two thousand fifteen; (II) the group had member
     8  employers, who, on or after  July  first,  two  thousand  fifteen,  have
     9  between  fifty-one  and  one hundred employees, exclusive of spouses and
    10  dependents; and (III) the group is either: (i) comprised entirely of one
    11  or more municipal corporations or districts (as such terms  are  defined
    12  in section one hundred nineteen-n of the general municipal law); or (ii)
    13  comprised entirely of nonpublic schools providing education in any grade
    14  from pre-kindergarten through twelfth grade.]
    15    § 8. Section 7 of chapter 12 of the laws of 2016 relating to directing
    16  the superintendent of financial services to contract with an independent
    17  entity  to conduct an assessment regarding the impact of the prohibition
    18  on the sale of stop loss, catastrophic and reinsurance coverage  to  the
    19  small group market, is REPEALED.
    20    §  9.  This  act shall take effect immediately; provided, however that
    21  the amendments to paragraph 1 of  subsection  (g)  and  paragraph  1  of
    22  subsection  (h)  of  section 3231, and paragraph 1 of subsection (d) and
    23  paragraph 1 of subsection (e) of section 4317 of the insurance law  made
    24  by  sections  six,  three, seven and five of this act respectively shall
    25  not affect the expiration and reversion of  such  paragraphs  and  shall
    26  expire and be deemed repealed therewith.