What's happening
This bill redefines "small group" for health insurance policies as groups with 1-50 employees, excluding spouses and dependents.
Why it matters
Narrows the definition of "small group" for insurance purposes to only include businesses with 1-50 employees, explicitly excluding spouses and dependents from the count. This could impact eligibility and pricing for businesses with 51-100 employees, who would no longer qualify for small group rates or protections.
May increase insurance costs or change available plan options for employers with 51-100 employees,. as they would be reclassified into the large group market, which is generally subject to different (often less consumer-protective) regulations and may have higher premiums.
Affects access to stop-loss, catastrophic, and reinsurance coverage for certain groups,. as insurers would be restricted from offering these products to groups that no longer qualify as "small groups" under the revised definition, potentially increasing risk exposure for some businesses.
Could influence the broader small business health insurance market in New York. by reducing the pool of businesses eligible for small group benefits, possibly altering risk-sharing dynamics and overall premium stability for remaining small group participants.
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Who cares
Headline styles
Redefine Small Group Insurance
Plain English, a few words. Used as the page title.
Sponsors
10 Co-sponsors
2 Multi-sponsors
History
- Referred to insurance
- Referred to insurance
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
172
2019-2020 Regular Sessions
IN ASSEMBLY (Prefiled)
January 9, 2019
Introduced by M. of A. CAHILL, GARBARINO, STIRPE, HEVESI, MAGNARELLI, ZEBROWSKI, STECK, QUART, RAIA, FRIEND, KOLB -- Multi-Sponsored by -- M. of A. FITZPATRICK, STEC -- read once and referred 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 Assembly, do enact as follows:
Section 1. Paragraph 1 of subsection (a) of section 3231 of the insurance 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 insurance policy covering between one and fifty employees or members of the group, except as set forth in subsection (h) 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 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 article.
§ 2. Paragraph 1 of subsection (h) of section 3231 of the insurance law, as amended by chapter 12 of the laws of 2016, 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-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01889-01-9
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ance, would be subject to this section. No insurer may provide stop loss, catastrophic or reinsurance coverage to small groups which, if they purchased insurance, would be subject to this section. Provided, however, the provisions of this paragraph shall not apply to: (A) the renewal of stop loss, catastrophic or reinsurance coverage issued and in effect on January first, two thousand fifteen to small groups covering between fifty-one and one hundred employees or members of the group; and (B) the issuance between January first, two thousand sixteen and December thirty-first, two thousand sixteen, of stop loss, catastrophic or reinsurance coverage, and any renewal thereof, to a small group covering between fifty-one and one hundred employees or members of the group, provided that such group had stop loss, catastrophic or reinsurance coverage issued and in effect on January first, two thousand fifteen. 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.
§ 3. 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 insurance, 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.
§ 4. 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 insurance 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 exclusive of spouses and dependents, including contracts for which the premiums 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.
§ 5. Paragraph 1 of subsection (e) of section 4317 of the insurance law, as amended by chapter 12 of the laws of 2016, 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 insurance, would be subject to this section. No insurer may provide stop loss, catastrophic or reinsurance coverage to small groups which, if they purchased insurance, would be subject to this section. Provided,
A. 172 3
however, the provisions of this paragraph shall not apply to: (A) the renewal of stop loss, catastrophic or reinsurance coverage issued and in effect on January first, two thousand fifteen to small groups covering between fifty-one and one hundred employees or members of the group; and (B) the issuance between January first, two thousand sixteen, and December thirty-first, two thousand sixteen, of stop loss, catastrophic or reinsurance coverage, and any renewal thereof, to a small group covering between fifty-one and one hundred employees or members of the group, provided that such group had stop loss, catastrophic or reinsurance coverage issued and in effect on January first, two thousand fifteen. 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.
§ 6. 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 insurance, 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.
§ 7. This act shall take effect immediately; provided, however the amendments to paragraph 1 of subsection (h) of section 3231 of the insurance law made by section two of this act shall be subject to the expiration and reversion of such paragraph pursuant to section 5 of chapter 588 of the laws of 2015, as amended, when upon such date the provisions of section three of this act shall take effect; and provided, further, the amendments to paragraph 1 of subsection (e) of section 4317 of the insurance law made by section five of this act shall be subject to the expiration and reversion of such paragraph pursuant to section 5 of chapter 588 of the laws of 2015, as amended, when upon such date the provisions of section six of this act shall take effect.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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