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

Summary of provisions

Section 1: Amends Insurance Law section 3231 to permit insurers and HMOs that offer individual or small group insurance policies to offer an actuarially appropriate premium discount or other benefits or enhancements to those individuals that Participate in a qualified wellness program. Such qualified wellness program must be approved by the Financial Services Department. Further, such qualified Wellness program can be either a risk management system that identifies at-risk populations or any other systematic program or course of medical conduct which helps to promote physical and mental fitness, helms to prevent or mitigate acute or chronic sickness, disease or Pain, or which minimizes adverse health consequences due to lifestyle. To protect all covered persons, the insurer or HMO shall not require specific medical outcomes as a result of an insured's adherence to the approved wellness program.

Section 2: Amends Insurance Law section 3239 which relates to Wellness Programs that can be sponsored by a health insurance plan. This provision expands the kinds of Wellness Programs that are covered under. the Insurance Law to include substance or alcohol abuse cessation programs and programs to manage and cope with chronic pain. In addition, the bill expands and provides for the full or partial reimbursement for the cost of participating in programs that are already currently authorized under this provision of the law, such as programs related to stress and or hypertension, worker injury prevention and nutrition education. Bill section 2 of this bill was recently amended such program could be contained in the policy or ancillary separate document and to add access to preventative care as one of the added benefits.

Section 3: Amends Insurance Law section 4235(h) to permit insurers and HMOs that offer accident and health insurance (large group policies) to offer an actuarially appropriate premium discount or other benefits or enhancements to those persons that participate in a qualified wellness program approved by the Superintendent.

Section 4: Amends Insurance Law section 4317 to permit Article 43 insurers and HMOs that offer individual or small group contracts to

offer, subject to the approval of the Superintendent, an actuarially appropriate premium discount or other enhancements to those persons that participate in a qualified wellness program by adding subsection c-1.

Section 5: Amends insurance Law section 4326 to permit insurers and HMOs that offer the subsidized "Healthy New York" policies to offer an actuarially appropriate premium discount or other enhancements to those persons that participate in a qualified wellness program.

Section 6: Amends Public Health Law section 4405 to provide for the same actuarially appropriate reduction in HMO health policies for those who participate in a Qualified wellness program.

Existing law

Under current law, health insurers and HMOs are not clearly allowed to offer an actuarially appropriate discount in premium rates to those persons that participate in a qualified wellness program.

Justification

Every year, health insurance rate payers are experiencing rapidly increasing premium rate increases. This increased cost of purchasing health insurance continues to force small and large businesses alike to drop health insurance coverage for their employees and their families. This bill provides a new avenue to help keep health insurance rates low. Further, it encourages persons, via a financial incentive, to participate in qualified wellness programs to enhance their physical and mental fitness and well-being.

We need to develop new and innovative ways to help to minimize future rate increases so that individuals will be able to afford the health care they need. Further, seducing or curtailing future health insurance premium increases will help to keep New York's businesses competitive with out of state firms.

Legislative history

2014 - S.2331 - Passed Senate. 2012 - S.4609 - Referred to Insurance

Implications

None.

Local fiscal implications

None.

Effective date

180 days after it shall have become law.