What's happening
This bill requires insurers and health maintenance organizations to notify individuals at least 30 days before group health insurance is terminated.
Why it matters
Direct notice to individuals. The bill requires insurers and HMOs to gather and update the residential addresses of all individuals covered under group health policies, ensuring that notifications of termination reach members directly, not just employers or group administrators.
Detailed information provided. Along with the termination notice, insurers and HMOs must include a comprehensive statement explaining the rights of the insured—such as coverage for conditions arising before or after termination and any other rights under the policy—helping individuals understand their options and next steps.
Delayed effectiveness of termination. Group health insurance termination cannot take effect until at least 30 days after the required notice is mailed, providing individuals with a buffer period to seek alternative coverage and avoid sudden gaps in their insurance.
Cost-sharing for notification. The policyholder (usually the employer or group organizer) is responsible for reimbursing the insurer or HMO for reasonable and necessary costs of sending these individual notices, potentially affecting administrative costs for organizations that offer group coverage.
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Who cares
Headline styles
Advance Notice for Coverage Loss
Plain English, a few words. Used as the page title.
Sponsors
1 Multi-sponsor
History
- Referred to insurance
- Referred to insurance
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Require 30-Day Termination Notice
In Senate Committee · Insurance · Sponsor Kevin S. Parker
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
4959
2017-2018 Regular Sessions
IN ASSEMBLY
February 6, 2017
Introduced by M. of A. WEPRIN -- Multi-Sponsored by -- M. of A. PERRY -read once and referred to the Committee on Insurance
AN ACT to amend the insurance law and the public health law, in relation to notification of termination of group health insurance
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subsection (a) of section 3221 of the insurance law is amended by adding a new paragraph 17 to read as follows:
(17) (A) That the insurer shall require the policyholder to provide it with the names and residential addresses of all individuals who because of their employee or membership status are certificate holders under such policy, and to update such information at least annually; and in the event the insurer terminates such policy, shall give each certificate holder at least thirty days prior written notice of termination of coverage, by mailing such notice to the last provided residential address for such certificate holder; provided, however, that such notice shall not be required where the policyholder has: (1) provided such certificate holder at least thirty days prior written notice of the termination of coverage, by mailing such notice to the certificate holder's last known residential address, or, if the certificate holder is represented by a labor organization, provided the representative of such labor organization with such written notice, or (2) has contracted with another insurer to provide similar coverage for the same certificate holders, and has provided certificate holders with the name of the substituted insurer. No termination of a group policy or contract of health, or accident and health insurance shall become effective until thirty days after the mailing of such notice of termination contract, if required.
(B) The insurer shall include with such notice a complete statement of the rights of the certificate holder under the termination of the policy as to coverage for illness, accident and treatment occurring prior to
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06674-01-7
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and subsequent to the termination date, and such other rights of certificate holders as may exist under the contract or policy or pursuant to paragraph one of subsection (e) of this section.
(C) Upon written request, the holder of the policy being terminated shall reimburse the insurer for all reasonable and necessary costs associated with providing such notice to certificate holders.
§ 2. Section 4305 of the insurance law is amended by adding a new subsection (n) to read as follows:
(n) (1) A group contract issued pursuant to this section shall contain a provision that the insurer shall require the group contract holder to provide it with the names and residential addresses of all individuals who because of their employee or membership status are certificate holders under such policy, and to update such information at least annually; and in the event the insurer terminates such policy, shall give each certificate holder at least thirty days prior written notice of termination of coverage, by mailing such notice to the last provided residential address for such certificate holder; provided, however, that such notice shall not be required where the group policyholder has: (A) provided such certificate holders at least thirty days prior written notice of the termination of coverage, by mailing such notice to such certificate holder's last known residential address, or, if such certificate holder is represented by a labor organization, provided the representative of such labor organization with such written notice, or (B) has contracted with another insurer to provide similar coverage for the same certificate holders, and has provided such certificate holders with the name of the substituted insurer. No termination of a group policy or contract of health, or accident and health insurance shall become effective until thirty days after the mailing of such notice of termination contract, if required.
(2) The insurer shall include with such notice a complete statement of the rights of the certificate holder under the termination of the policy as to coverage for illness, accident and treatment occurring prior to and subsequent to the termination date, and such other rights of certificate holders as may exist under the contract or policy or pursuant to paragraph one of subsection (d) of this section.
(3) Upon written request, the holder of the group policy being terminated shall reimburse the insurer for all reasonable and necessary costs associated with providing such notice to certificate holders.
§ 3. The public health law is amended by adding a new section 4407-a to read as follows:
§ 4407-a. Group contracts; notification of cancellation requirements. 1. A health maintenance organization shall require a policyholder to provide it with the names and residential addresses of all individuals who because of their employee or membership status are members in such health maintenance organization, and to update such information at least annually; and in the event the health maintenance organization terminates such policy, shall give each such member at least thirty days prior written notice of termination of coverage, by mailing such notice to the last provided residential address for such member; provided, however, that such notice shall not be required where the policyholder has: (a) provided such member at least thirty days prior written notice of the termination of coverage, by mailing such notice to such member's last known residential address, or, if the member is represented by a labor organization, provided the representative of such labor organization with such written notice, or (b) has contracted with another health maintenance organization or insurer to provide similar coverage for the
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same members, and has provided members with the name of the substituted health maintenance organization or insurer. No termination of a group policy or contract of health, or accident and health insurance shall become effective until thirty days after the mailing of such notice of termination contract, if required.
2. The health maintenance organization shall include with such notice a complete statement of the rights of the member under the termination of the policy as to coverage for illness, accident and treatment occurring prior to and subsequent to the termination date, and such other rights of members as may exist under the contract or policy or pursuant to this article and article forty-three of the insurance law.
3. Upon written request, the holder of the policy being terminated shall reimburse the health maintenance organization for all reasonable and necessary costs associated with providing such notice to members.
§ 4. This act shall take effect on the ninetieth day after it shall have become a law.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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