Bill S6917-2013

Redefines "small group" for the purposes of sections 3231 and 4317 of the insurance law

Redefines "small group" for the purposes of certain provisions of sections 3231 and 4317 of the insurance law.

Details

Actions

  • Jun 19, 2014: referred to insurance
  • Jun 19, 2014: DELIVERED TO ASSEMBLY
  • Jun 19, 2014: PASSED SENATE
  • May 7, 2014: ADVANCED TO THIRD READING
  • May 6, 2014: 2ND REPORT CAL.
  • May 5, 2014: 1ST REPORT CAL.492
  • Mar 31, 2014: REFERRED TO INSURANCE

Meetings

Calendars

Votes

VOTE: COMMITTEE VOTE: - Insurance - May 5, 2014
Ayes (18): Seward, Carlucci, Flanagan, Golden, Grisanti, Lanza, Larkin, LaValle, Martins, O'Mara, Young, Avella, Breslin, Espaillat, Kennedy, Parker, Stavisky, O'Brien
Ayes W/R (1): Peralta

Memo

BILL NUMBER:S6917

TITLE OF BILL: An act to amend the insurance law, in relation to rating of individual and small group health insurance contracts and policies

PURPOSE:

To amend the insurance law to preserve the current stop loss insurance market.

SUMMARY OF PROVISIONS:

Section 1 of the bill provides an exception to the definition of small group coverage when coverage is written by a commercial insurer.

Section 2 of the bill provides that the prohibition against a commercial insurer acting as a third party administrator or providing stop loss coverage to self-funded small groups would continue to apply only to small groups of fifty or fewer employees or members.

Section 3 of the bill provides an exception to the definition of small group coverage when coverage is written by a corporation organized under Article 43 of the Insurance Law.

Section 4 of the bill provides that the prohibition against an Article 43 corporation acting as a third party administrator or providing stop loss coverage to self-funded small groups would continue to apply only to small groups of fifty or fewer employees or members.

Section 5 of the bill sets forth the effective date.

JUSTIFICATION:

Since 1993, insurance companies have been permitted to write stop loss insurance and to provide administrative services to self-funded employer groups with 51 or more employees. A redefinition of what constitutes a small group, designed to comply with the federal Affordable Care Act, had the inadvertent effect of prohibiting insurers from continuing to issue stop loss coverage to groups with between 51 and 100 employees effective 2016. This bill will allow the current stop loss marketplace to operate uninterrupted for self-insured groups without directly impacting the insured small group market.

LEGISLATIVE HISTORY:

New bill.

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

Immediately.


Text

STATE OF NEW YORK ________________________________________________________________________ 6917 IN SENATE March 31, 2014 ___________
Introduced by Sen. SEWARD -- 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 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: Section 1. Paragraph 1 of subsection (a) of section 3231 of the insur- ance law, as amended by section 69 of part D of chapter 56 of the laws of 2013, is amended to read as follows: (1) No individual health insurance policy and no group health insur- ance policy covering between one and fifty employees or members of the groupr, EXCEPT AS SET FORTH IN SUBSECTION (H) OF THIS SECTION, or between one and one hundred employees or members of the group for poli- cies issued or renewed on or after January first, two thousand sixteen exclusive of spouses and dependents, hereinafter referred to as a small group, providing hospital and/or medical benefits, including medicare supplemental insurance, shall be issued in this state unless such policy is community rated and, notwithstanding any other provisions of law, the underwriting of such policy involves no more than the imposition of a pre-existing condition limitation if otherwise permitted by this arti- cle. S 2. Paragraph 1 of subsection (h) of section 3231 of the insurance law, as added by chapter 501 of the laws of 1992, is amended to read as follows: (1) Notwithstanding any other provision of this chapter, no insurer, subsidiary of an insurer, or controlled person of a holding company system may act as an administrator or claims paying agent, as opposed to an insurer, on behalf of small groups which, if they purchased insur- ance, would be subject to this section. No insurer, subsidiary of an insurer, or controlled person of a holding company may provide stop loss, catastrophic or reinsurance coverage to small groups which, if they purchased insurance, would be subject to this section. FOR PURPOSES OF THIS SUBSECTION, "SMALL GROUP" SHALL MEAN A GROUP COMPRISED OF
BETWEEN ONE AND FIFTY EMPLOYEES OR MEMBERS, EXCLUSIVE OF SPOUSES AND DEPENDENTS. S 3. Paragraph 1 of subsection (a) of section 4317 of the insurance law, as amended by section 72 of part D of chapter 56 of the laws of 2013, is amended to read as follows: (1) No individual health insurance contract and no group health insur- ance contract covering between one and fifty employees or members of the group, EXCEPT AS SET FORTH IN SUBSECTION (E) OF THIS SECTION, or between one and one hundred employees or members of the group for policies issued or renewed on or after January first, two thousand sixteen exclu- sive of spouses and dependents, including contracts for which the premi- ums are paid by a remitting agent for a group, hereinafter referred to as a small group, providing hospital and/or medical benefits, including Medicare supplemental insurance, shall be issued in this state unless such contract is community rated and, notwithstanding any other provisions of law, the underwriting of such contract involves no more than the imposition of a pre-existing condition limitation if otherwise permitted by this article. S 4. Paragraph 1 of subsection (e) of section 4317 of the insurance law, as amended by section 72 of part D of chapter 56 of the laws of 2013, is amended to read as follows: (1) Notwithstanding any other provision of this chapter, no insurer, subsidiary of an insurer, or controlled person of a holding company system may act as an administrator or claims paying agent, as opposed to an insurer, on behalf of small groups which, if they purchased insur- ance, would be subject to this section. No insurer, subsidiary of an insurer, or controlled person of a holding company may provide stop loss, catastrophic or reinsurance coverage to small groups which, if they purchased insurance, would be subject to this section. FOR PURPOSES OF THIS SUBSECTION, "SMALL GROUP" SHALL MEAN A GROUP COMPRISED OF BETWEEN ONE AND FIFTY EMPLOYEES OR MEMBERS, EXCLUSIVE OF SPOUSES AND DEPENDENTS. S 5. This act shall take effect immediately.

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