Bill Text: NY S01783 | 2017-2018 | 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: Partisan Bill (Democrat 6-0)
Status: (Engrossed - Dead) 2018-06-20 - COMMITTED TO RULES [S01783 Detail]
Download: New_York-2017-S01783-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 1783 2017-2018 Regular Sessions IN SENATE January 10, 2017 ___________ Introduced by Sens. KLEIN, AVELLA, CARLUCCI, SAVINO, VALESKY -- 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: 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 21 that are detrimental to human health. In addition, information on the 22 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. LBD07344-01-7S. 1783 2 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 this article; 7 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 insurer or health maintenance organization shall not require specific 15 outcomes as a result of an enrollee's or insured's adherence to the 16 approved wellness program. 17 § 2. Subsections (a), (b) and (c) of section 3239 of the insurance 18 law, subsection (a) as added by chapter 592 of the laws of 2008, and 19 subsections (b) and (c) as amended by chapter 180 of the laws of 2016, 20 are amended to read as follows: 21 (a) An insurer licensed to write accident and health insurance, a 22 corporation organized pursuant to article forty-three of this chapter, a 23 health maintenance organization certified pursuant to article forty-four 24 of the public health law and a municipal cooperative health benefits 25 plan may establish a wellness program in conjunction with its issuance 26 of a group accident and health insurance policy or group subscriber 27 contract. A "wellness program" is a program designed to promote health 28 and prevent disease that may contain rewards and incentives for partic- 29 ipation. Participation in the wellness program shall be available to 30 similarly-situated members of the group and shall be voluntary on the 31 part of the member. The specific terms of the wellness program shall be 32 set forth in the policy or contract, or in a separate document provided 33 to insureds and members which shall be consistent with the provisions of 34 this section. 35 (b) A wellness program may include, but is not limited to, the follow- 36 ing programs or services: 37 (1) the use of a health risk assessment tool; 38 (2) a smoking cessation program; 39 (3) a weight management program; 40 (4) a stress and/or hypertension management program; 41 (5) a worker injury prevention program; 42 (6) a nutrition education program; 43 (7) health or fitness incentive programs; 44 (8) a coordinated weight management, nutrition, stress management and 45 physical fitness program to combat the high incidence of adult and 46 childhood obesity, asthma and other chronic respiratory conditions; 47 (9) a substance or alcohol abuse cessation program; [and] 48 (10) a program to manage and cope with chronic pain[.] ; 49 (11) assistance, financial or otherwise, provided to an employer for 50 health promotion and disease prevention; and 51 (12) incentives for insureds or members to access preventive services, 52 such as mammography screening. 53 (c)(1) A wellness program may use rewards and incentives for partic- 54 ipation provided that where the group health insurance policy or 55 subscriber contract is required to be community-rated, the rewards and 56 incentives shall not include a discounted premium rate or a rebate orS. 1783 3 1 refund of premium, except as provided in section three thousand two 2 hundred thirty-one of this article, or section four thousand two hundred 3 thirty-five, four thousand three hundred seventeen or four thousand 4 three hundred twenty-six of this chapter, or section forty-four hundred 5 five of the public health law. 6 (2) Permissible rewards and incentives may include: 7 (A) full or partial reimbursement of the cost of participating in 8 smoking cessation, weight management, stress and/or hypertension, worker 9 injury prevention, nutrition education, substance or alcohol abuse 10 cessation, or chronic pain management and coping programs; 11 (B) full or partial reimbursement of the cost of membership in a 12 health club or fitness center; 13 (C) the waiver or reduction of copayments, coinsurance and deductibles 14 for preventive services covered under the group policy or subscriber 15 contract; 16 (D) monetary rewards in the form of gift cards or gift certificates, 17 so long as the recipient of the reward is encouraged to use the reward 18 for a product or a service that promotes good health, such as healthy 19 cook books, over the counter vitamins or exercise equipment; 20 (E) full or partial reimbursement of the cost of participating in a 21 stress management program or activity; and 22 (F) full or partial reimbursement of the cost of participating in a 23 health or fitness program. 24 (3) Where the reward involves a group member's meeting a specified 25 standard based on a health condition, the wellness program must meet the 26 requirements of 45 CFR Part 146. 27 (4) A reward or incentive which involves a discounted premium rate or 28 a rebate or refund of premium shall be based on actuarial demonstration 29 that the wellness program can reasonably be expected to result in the 30 overall good health and well being of the group as provided in section 31 three thousand two hundred thirty-one of this article, sections four 32 thousand two hundred thirty-five, four thousand three hundred seventeen 33 and four thousand three hundred twenty-six of this chapter, and section 34 forty-four hundred five of the public health law. 35 § 3. Subsection (h) of section 4235 of the insurance law is amended by 36 adding a new paragraph 5 to read as follows: 37 (5) Each insurer doing business in this state, when filing with the 38 superintendent its schedules of premium rates, rules and classification 39 of risks for use in connection with the issuance of its policies of 40 group accident, group health or group accident and health insurance, may 41 provide for an actuarially appropriate reduction in premium rates or 42 other benefits or enhancements approved by the superintendent to encour- 43 age an enrollee's or insured's active participation in a qualified well- 44 ness program. A qualified wellness program can be a risk management 45 system that identifies at-risk populations or any other systematic 46 program or course of medical conduct which helps to promote physical and 47 mental fitness, health and well-being, helps to prevent or mitigate the 48 conditions of acute or chronic sickness, disease or pain, or which mini- 49 mizes adverse health consequences due to lifestyle. Such a wellness 50 program may have some or all of the following elements to advance the 51 physical health and mental well-being of its participants: 52 (A) an education program to increase the awareness of and dissem- 53 ination of information about pursuing healthier lifestyles, and which 54 warns about risks of pursuing environmental or behavioral activities 55 that are detrimental to human health. In addition, information on the 56 availability of health screening tests to assist in the early identifi-S. 1783 4 1 cation and treatment of diseases such as cancer, heart disease, hyper- 2 tension, diabetes, asthma, obesity or other adverse health afflictions; 3 (B) 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 this chapter; 7 (C) the monitoring of the progress of each covered person to track his 8 or her adherence to such wellness program and to provide assistance and 9 moral support to such covered person to assist him or her to attain the 10 goals of the covered person's wellness program. 11 Such wellness program shall demonstrate actuarially that it encourages 12 the general good health and well-being of the covered population. The 13 insurer or health maintenance organization shall not require specific 14 outcomes as a result of an enrollee's or insured's adherence to the 15 approved wellness program. 16 § 4. Section 4317 of the insurance law is amended by adding a new 17 subsection (c-1) to read as follows: 18 (c-1) Subject to the approval of the superintendent, an insurer or 19 health maintenance organization issuing an individual or group health 20 insurance contract pursuant to this section may provide for an actuari- 21 ally appropriate reduction in premium rates or other benefits or 22 enhancements approved by the superintendent to encourage an enrollee's 23 or insured's active participation in a qualified wellness program. A 24 qualified wellness program can be a risk management system that identi- 25 fies at-risk populations or any other systematic program or course of 26 medical conduct which helps to promote physical and mental fitness, 27 health and well-being, helps to prevent or mitigate the conditions of 28 acute or chronic sickness, disease or pain, or which minimizes adverse 29 health consequences due to lifestyle. Such a wellness program may have 30 some or all of the following elements to advance the physical health and 31 mental well-being of its participants: 32 (1) an education program to increase the awareness of and dissem- 33 ination of information about pursuing healthier lifestyles, and which 34 warns about risks of pursuing environmental or behavioral activities 35 that are detrimental to human health. In addition, information on the 36 availability of health screening tests to assist in the early identifi- 37 cation and treatment of diseases such as cancer, heart disease, hyper- 38 tension, diabetes, asthma, obesity or other adverse health afflictions; 39 (2) a program that encourages behavioral practices that either encour- 40 age healthy living activities or discourage unhealthy living activities. 41 Such activities or practices may include wellness programs, as provided 42 under section three thousand two hundred thirty-nine of this chapter; 43 and 44 (3) the monitoring of the progress of each covered person to track his 45 or her adherence to such wellness program and to provide assistance and 46 moral support to such covered person to assist him or her to attain the 47 goals of the covered person's wellness program. 48 Such wellness program shall demonstrate actuarially that it encourages 49 the general good health and well-being of the covered population. The 50 insurer or health maintenance organization shall not require specific 51 outcomes as a result of an enrollee's or insured's adherence to the 52 approved wellness program. 53 § 5. Subsection (m) of section 4326 of the insurance law is amended by 54 adding a new paragraph 4 to read as follows: 55 (4) approval of the superintendent, an insurer or health maintenance 56 organization issuing a contract for qualifying small employers or indi-S. 1783 5 1 viduals pursuant to this section may provide for an actuarially appro- 2 priate reduction in premium rates or other benefits or enhancements 3 approved by the superintendent to encourage an enrollee's or insured's 4 active participation in a qualified wellness program. A qualified well- 5 ness program can be a risk management system that identifies at-risk 6 populations or any other systematic program or course of medical conduct 7 which helps to promote physical and mental fitness, health and well-be- 8 ing, helps to prevent or mitigate the conditions of acute or chronic 9 sickness, disease or pain, or which minimizes adverse health conse- 10 quences due to lifestyle. Such a wellness program may have some or all 11 of the following elements to advance the physical health and mental 12 well-being of its participants: 13 (A) an education program to increase the awareness of and dissem- 14 ination of information about pursuing healthier lifestyles, and which 15 warns about risks of pursuing environmental or behavioral activities 16 that are detrimental to human health. In addition, information on the 17 availability of health screening tests to assist in the early identifi- 18 cation and treatment of diseases such as cancer, heart disease, hyper- 19 tension, diabetes, asthma, obesity or other adverse health afflictions; 20 (B) a program that encourages behavioral practices that either encour- 21 age healthy living activities or discourage unhealthy living activities. 22 Such activities or practices may include wellness programs, as provided 23 under section three thousand two hundred thirty-nine of this chapter; 24 and 25 (C) the monitoring of the progress of each covered person to track his 26 or her adherence to such wellness program and to provide assistance and 27 moral support to such covered person to assist him or her to attain the 28 goals of the covered person's wellness program. 29 Such wellness program shall demonstrate actuarially that it encourages 30 the general good health and well-being of the covered population. The 31 insurer or health maintenance organization shall not require specific 32 outcomes as a result of an enrollee's or insured's adherence to the 33 approved wellness program. 34 § 6. Section 4405 of the public health law is amended by adding a new 35 subdivision 5-a to read as follows: 36 5-a. subject to the approval of the superintendent of financial 37 services, the possible providing of an actuarially appropriate reduction 38 in premium rates or other benefits or enhancements approved by the 39 superintendent of financial services to encourage an enrollee's active 40 participation in a qualified wellness program. A qualified wellness 41 program can be a risk management system that identifies at-risk popu- 42 lations or any other systematic program or course of medical conduct 43 which helps to promote physical and mental fitness, health and well-be- 44 ing, helps to prevent or mitigate the conditions of acute or chronic 45 sickness, disease or pain, or which minimizes adverse health conse- 46 quences due to lifestyle. Such a wellness program may have some or all 47 of the following elements to advance the physical health and mental 48 well-being of its participants: 49 (1) an education program to increase the awareness of and dissem- 50 ination of information about pursuing healthier lifestyles, and which 51 warns about risks of pursuing environmental or behavioral activities 52 that are detrimental to human health. In addition, information on the 53 availability of health screening tests to assist in the early identifi- 54 cation and treatment of diseases such as cancer, heart disease, hyper- 55 tension, diabetes, asthma, obesity or other adverse health afflictions;S. 1783 6 1 (2) a program that encourages behavioral practices that either encour- 2 age healthy living activities or discourage unhealthy living activities. 3 Such activities or practices may include wellness programs, as provided 4 under section three thousand two hundred thirty-nine of the insurance 5 law; and 6 (3) the monitoring of the progress of each covered person to track his 7 or her adherence to such wellness program and to provide assistance and 8 moral support to such covered person to assist him or her to attain the 9 goals of the covered person's wellness program. 10 Such wellness program shall demonstrate actuarially that it encourages 11 the general good health and well-being of the covered population. The 12 health maintenance organization shall not require specific outcomes as a 13 result of an enrollee's adherence to the approved wellness program; 14 § 7. This act shall take effect on the one hundred eightieth day after 15 it shall have become a law; provided that if chapter 180 of the laws of 16 2016 shall not have taken effect on such effective date, then section 17 two of this act shall take effect on the same date and in the same 18 manner as such chapter takes effect; provided further effective imme- 19 diately any rules and regulations necessary to implement the provisions 20 of this act on its effective date are authorized and directed to be 21 added, amended and/or repealed on or before such date.
