Bill S3991-2011

Authorizes health insurers to provide actuarially appropriate reductions in health insurance premiums for participation in a wellness program

Authorizes health insurers, subject to the approval of the superintendent of insurance, to provide actuarially appropriate reductions in health insurance premiums for an enrollee's or insured's participation in a wellness program (defined); provides for the appointment of an advisory committee on wellness to be co-chaired by the commissioner of health and the superintendent of insurance and to report on the development and effectiveness of wellness programs.

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  • Jan 4, 2012: REFERRED TO INSURANCE
  • Mar 11, 2011: REFERRED TO INSURANCE

Memo

BILL NUMBER:S3991

TITLE OF BILL: An act to amend the insurance law, in relation to making actuarially appropriate reductions in health insurance premiums in return for an enrollee's or insured's participation in a bona fide wellness program; and to establish an advisory committee on wellness to report thereon

PURPOSE: To help curtail future health insurance premium increases, this legislation permits health insurers and health maintenance organizations (HMOs) to offer an actuarially appropriate premium discount to covered persons that participate in a bona fide wellness program that is approved by the Superintendent of Insurance.

SUMMARY OF PROVISIONS: § 1- Amends §3231 of the Insurance Law to permit insurers and HMOs that offer individual or small group insurance policies to offer an actuarially appropriate premium discount to those individuals that participate in a bona fide wellness program. A bona fide wellness program is one that is approved by the Superintendent of Insurance and which is either a risk management system that identifies at-risk populations or any other systematic program or course of medical conduct which helps to promote good health, helps to prevent or mitigate acute or chronic sickness or disease, or which minimizes adverse health consequences due to lifestyle. To ensure that the community rating laws are not affected, the insurer or HMO shall not require specific medical outcomes as a result of an insured's adherence to the approved wellness program.

§2- Amends subsection (h) of §4235 of the Insurance Law to permit insurers and HMO's that offer accident and health insurance (large group policies) to offer an actuarially appropriate premium discount to those persons that participate in a bona fide wellness program approved by the Superintendent.

§3- Amends §4317 of the Insurance Law to permit Article 43 insurers and HMO's that offer individual or small group contracts to offer, subject to the approval of the Superintendent, an actuarially appropriate premium discount to those persons that participate in a bona fide wellness program.

§4- Amends subsection (n) of §4326 of the Insurance Law to permit insurers and HMO's that offer the new subsidized "Healthy New York" policies to offer an actuarially appropriate premium discount to those persons that participate in a wellness program.

§5- Creates a 15 member Blue Ribbon Advisory Committee on Wellness to be chaired by the Commissioner of Health and Superintendent of Insurance or their designees. This Committee shall look into and make recommendations on developing a comprehensive wellness program that can be implemented by New York State, local county health departments, hospitals, physicians, insurers, HMOs and other health care providers.

§6- Effective date.

EXISTING LAW: Currently, the Insurance Law does not authorize insurers and HMOs to offer an actuarially appropriate discount in premium rates to those persons that participate in a bona fide wellness program.

JUSTIFICATION: This year in the Hudson Valley and in other parts of this state, many health insurance rate payers are experiencing rate increases of between 10 to 20 percent. This significantly increased cost of health insurance may encourage small and large businesses to drop health insurance coverage for their employees and make the cost of health insurance even more prohibitive for those in the individual direct pay market.

New York State needs to develop more innovative ways to help to minimize future rate increases so that individuals will be able to obtain the health care they need. This bill establishes a blue ribbon advisory committee on wellness whose charge shall be to investigate and develop innovative ways to alter how health care is provided and financed so as to encourage general good health and well-being of this state's citizens. Encouraging a more systematic approach to increasing the good health of the state's population will not only enhance quality of life, it will also help to reduce health care costs and hence premiums charged to individuals and large & small employers. In addition, reducing or curtailing subsequent health insurance premium increases will assist New York's businesses to remain competitive in this world market and keep down the cost of doing business in this state.

This legislation is not an insurance mandate bill in that it merely permits, it does not require, insurers and HMOs to develop or implement Wellness programs for its insureds. It is hoped that some of the wellness programs may be developed in conjunction with the Advisory Committee.

LEGISLATIVE HISTORY: 2009-2010: A.2867/S.651; 2007-2008: A.2357/S.204; 2005-2006: A.3683/S.413; 2003-2004: A.3344/S.1223, 2001-2002: A.5851/S.2186.

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect immediately.


Text

STATE OF NEW YORK ________________________________________________________________________ 3991 2011-2012 Regular Sessions IN SENATE March 11, 2011 ___________
Introduced by Sen. LARKIN -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law, in relation to making actuarially appropriate reductions in health insurance premiums in return for an enrollee's or insured's participation in a bona fide wellness program; and to establish an advisory committee on wellness to report thereon THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 3231 of the insurance law, as added by chapter 501 of the laws of 1992, is amended by adding a new subsection (c-1) to read as follows: (C-1) SUBJECT TO THE APPROVAL OF THE SUPERINTENDENT, AN INSURER OR HEALTH MAINTENANCE ORGANIZATION ISSUING AN INDIVIDUAL OR GROUP HEALTH INSURANCE POLICY PURSUANT TO THIS SECTION MAY PROVIDE AN ACTUARIALLY APPROPRIATE REDUCTION IN PREMIUM RATES IN RETURN FOR AN ENROLLEE'S OR INSURED'S ADHERENCE TO A BONA FIDE WELLNESS PROGRAM. A BONA FIDE WELL- NESS PROGRAM IS EITHER A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE GOOD HEALTH, HELPS TO PREVENT OR MITIGATE ACUTE OR CHRONIC SICKNESS OR DISEASE, OR WHICH MINIMIZES ADVERSE HEALTH CONSE- QUENCES DUE TO LIFESTYLE. SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTU- ARIALLY THAT IT ENCOURAGES THE GENERAL GOOD HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A RESULT OF AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM. S 2. Subsection (h) of section 4235 of the insurance law is amended by adding a new paragraph 5 to read as follows: (5) EACH DOMESTIC, FOREIGN OR ALIEN INSURER DOING BUSINESS IN THIS STATE, WHEN FILING WITH THE SUPERINTENDENT ITS SCHEDULES OF PREMIUM RATES, RULES AND CLASSIFICATION OF RISKS FOR USE IN CONNECTION WITH THE ISSUANCE OF ITS POLICIES OF GROUP ACCIDENT, GROUP HEALTH OR GROUP ACCI-
DENT AND HEALTH INSURANCE, MAY PROVIDE FOR AN ACTUARIALLY APPROPRIATE REDUCTION IN PREMIUM RATES IN RETURN FOR AN ENROLLEE'S OR INSURED'S ADHERENCE TO A BONA FIDE WELLNESS PROGRAM. A BONA FIDE WELLNESS PROGRAM IS EITHER A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE GOOD HEALTH, HELPS TO PREVENT OR MITIGATE ACUTE OR CHRONIC SICKNESS OR DISEASE, OR WHICH MINIMIZES ADVERSE HEALTH CONSEQUENCES DUE TO LIFESTYLE. SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES THE GENERAL GOOD HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A RESULT OF AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM. S 3. Section 4317 of the insurance law is amended by adding a new subsection (c-1) to read as follows: (C-1) SUBJECT TO THE APPROVAL OF THE SUPERINTENDENT, AN INSURER OR HEALTH MAINTENANCE ORGANIZATION ISSUING AN INDIVIDUAL OR GROUP HEALTH INSURANCE CONTRACT PURSUANT TO THIS SECTION MAY PROVIDE AN ACTUARIALLY APPROPRIATE REDUCTION IN PREMIUM RATES IN RETURN FOR AN ENROLLEE'S OR INSURED'S ADHERENCE TO A BONA FIDE WELLNESS PROGRAM. A BONA FIDE WELL- NESS PROGRAM IS EITHER A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE GOOD HEALTH, HELPS TO PREVENT OR MITIGATE ACUTE OR CHRONIC SICKNESS OR DISEASE, OR WHICH MINIMIZES ADVERSE HEALTH CONSE- QUENCES DUE TO LIFESTYLE. SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTU- ARIALLY THAT IT ENCOURAGES THE GENERAL GOOD HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A RESULT OF AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM. S 4. Subsection (n) of section 4326 of the insurance law is amended by adding a new paragraph 4 to read as follows: (4) APPROVAL OF THE SUPERINTENDENT, AN INSURER OR HEALTH MAINTENANCE ORGANIZATION ISSUING A CONTRACT FOR QUALIFYING SMALL EMPLOYERS OR INDI- VIDUALS PURSUANT TO THIS SECTION MAY PROVIDE AN ACTUARIALLY APPROPRIATE REDUCTION IN PREMIUM RATES IN RETURN FOR AN ENROLLEE'S OR INSURED'S ADHERENCE TO A BONA FIDE WELLNESS PROGRAM. A BONA FIDE WELLNESS PROGRAM IS EITHER A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE GOOD HEALTH, HELPS TO PREVENT OR MITIGATE ACUTE OR CHRONIC SICKNESS OR DISEASE, OR WHICH MINIMIZES ADVERSE HEALTH CONSEQUENCES DUE TO LIFESTYLE. SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES THE GENERAL GOOD HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A RESULT OF AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM. S 5. a. The commissioner of health and the superintendent of insurance shall convene an advisory committee on wellness to examine and make recommendations to the governor and legislature on issues, including but not limited to: (1) methods to more efficiently disseminate information about more healthful lifestyles to promote a reduction in acute or chronic illnesses, how to develop innovative wellness programs that can be implemented by insurers, health maintenance organizations, hospitals, physicians and other health care providers, whether or not the provision of health care and its financing can be restructured to encourage gener- al good health and well-being of this state's citizens, whether or not other incentives, both monetary and non-monetary, can be developed to
encourage persons to pursue more healthy lifestyles, and survey and make suggestions on how to improve the effectiveness of programs currently being administered by state, county and local governments that promote good health. (2) the cost effectiveness of developing or expanding current wellness programs administered by state and local governments, hospitals, public and private schools and clinics, health insurers and health maintenance organizations that provide for early prenatal care, cancer screenings, asthma and diabetes identification and treatments, childhood immuniza- tions, and early risk management systems to identify at-risk popu- lations. (3) whether or not more research should be encouraged, to be conducted by private organizations and the department of health, to determine if disparities exist in the diagnosis and medical treatment of individuals based on variables such as age, race, gender, ethnicity or other cultural factors, and whether or not it is advisable to establish age, race, gender or ethnic based testing and screening examination schedules to identify the early onset of illness or disease. b. The advisory committee on wellness shall be comprised of fifteen members, and co-chaired by the commissioner of health and the super- intendent of insurance, or their designees. The governor shall appoint seven members to the committee and the temporary president of the senate and the speaker of the assembly shall each appoint three members to the committee, and the minority leaders of the senate and assembly shall each appoint one member. The appointees shall be representatives of health insurers, hospitals, physicians, clinics, other health care providers such as those that specialize in the provision of mental health, chiropractic and homeopathic care, state agencies such as the office of mental health, the departments of environmental conservation, and agriculture and markets, county and other local health department personnel, and school board officials. The appointees shall be named no later than 120 days after the effective date of this section. After evaluating the issues stated in subdivision a of this section, the committee shall deliver a report within a year of the effective date of this section on its findings on such issues to the governor, temporary president of the senate, speaker of the assembly, and the minority lead- ers of the senate and assembly. Such report shall contain the results of its evaluation and any findings or recommendations on enhancing the good health and well-being of the state's residents. S 6. This act shall take effect immediately.

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