What's happening
This bill amends the process for approving health insurance premium changes, setting stricter timelines, actuarial standards, and notice requirements.
Why it matters
Stricter, Faster Review Process. The bill tightens the timeline for the Department of Financial Services (DFS) to review and decide on health insurance premium change requests, reducing the maximum initial review period from 60 to 30 days. This may speed up the approval or rejection of premium changes, affecting how quickly consumers see new rates and improving predictability for insurers.
Higher Actuarial Standards and Transparency. Any rate change must now be justified according to "generally accepted actuarial principles and practices," and the final decision must be certified by a qualified actuary. The DFS must also provide detailed explanations of the actuarial assumptions used in their decisions, potentially increasing transparency and public trust in the rate-setting process.
Shorter and Broader Notice Requirements. Insurers must notify policyholders and certificate holders of proposed rate changes at the time of filing, and if a rate is approved, give at least 30 days’ notice (down from 60), either in writing or via their website. This may improve consumer awareness but gives less time to react to premium increases.
Clear Appeal and Comment Mechanisms. The bill formalizes a 15-day window for insurers to appeal initial DFS rate determinations and requires DFS to respond within 15 days if an appeal is filed. It also ensures consumers can comment on proposed rate changes, and that all comments are posted publicly, which could make the process more participatory and responsive to public input.
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Who cares
Headline styles
Speed Up Insurance Rate Reviews
Plain English, a few words. Used as the page title.
Sponsors
3 Co-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
206
2019-2020 Regular Sessions
IN ASSEMBLY (Prefiled)
January 9, 2019
Introduced by M. of A. CAHILL, STECK, SCHIMMINGER, RAIA -- 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 policies
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subparagraph (A) of paragraph 1 of subsection (e) of section 3231 of the insurance law, as amended by chapter 107 of the laws of 2010 and as further amended by section 104 of part A of chapter 62 of the laws of 2011, is amended to read as follows:
(A) An insurer desiring to increase or decrease premiums for any policy form subject to this section shall submit a rate filing or application to the superintendent.
An insurer shall send written notice of the proposed rate adjustment, [including the specific change requested,] to each policy holder and certificate holder affected by the adjustment on or before the date the rate filing or application is submitted to the superintendent. The notice shall prominently include mailing and website addresses for both the department of financial services and the insurer through which a person may, within thirty days from the date the rate filing or application is submitted to the superintendent, contact the department of financial services or insurer to receive additional information or to submit written comments to the department of financial services on the rate filing or application. The superintendent shall establish a process to post on the department's website, in a timely manner, all relevant written comments received pertaining to rate filings or applications. The insurer shall provide a copy of the notice to the superintendent with the rate filing or application. The superintendent shall immediately cause the notice to be posted on the department of financial services' website. The superintendent shall determine whether the filing
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00054-01-9
A. 206 2
or application shall become effective as filed, shall become effective as modified, or shall be disapproved. The superintendent may modify or disapprove the rate filing or application if the superintendent finds that the premiums are unreasonable, excessive, inadequate, or unfairly discriminatory, and may consider the financial condition of the insurer when approving, modifying or disapproving any premium adjustment. [The] Provided, however, any adjustment to a rate filing or application must be in accordance with generally accepted actuarial principles and practices, and must be appropriate for the population to be covered and services to be furnished under the policy. An initial determination [of] regarding the rate filing or application shall be made by the superintendent [shall be supported by sound actuarial assumptions and methods, and shall be rendered in writing between] no later than thirty [and sixty] days from the date the rate filing or application is submitted to the superintendent. The superintendent's initial determination shall be provided to an insurer in writing within the thirty day time period and shall describe in detail the actuarial assumptions and methods used in the superintendent's determination. Should the superintendent require additional information from the insurer in order to make [a] an initial determination, the superintendent shall require the insurer to furnish such information, and in such event, the [sixty] thirty days shall be tolled and shall resume as of the date the insurer furnishes the information to the superintendent. [If the superintendent requests additional information less than ten days from the expiration of the sixty days (exclusive of tolling), the superintendent may extend the sixty day period an additional twenty days to make a determination. The] Following the issuance of the initial determination, an insurer shall have fifteen days to appeal the determination in writing. If an initial rate determination is appealed, the superintendent shall have fifteen days to issue a revised determination. If the initial determination is not appealed by an insurer, it shall become final fifteen days after it is issued. All final rate determinations shall be certified by an actuary designated by the superintendent who meets the qualification standards established by the American academy of actuaries and follow the practice standards established by the actuarial standards board. Notwithstanding the foregoing, the application or rate filing will be deemed approved if a determination is not rendered within the time allotted under this section. An insurer shall not implement a rate adjustment that is approved by the superintendent unless the insurer provides at least [sixty] thirty days advance [written] notice of the [premium rate adjustment approved by the superintendent] adjustment, either through a posting on its website or by written notice to each policy holder and certificate holder affected by the rate adjustment.
§ 2. Paragraph 2 of subsection (c) of section 4308 of the insurance law, as amended by chapter 107 of the laws of 2010 and as further amended by section 104 of part A of chapter 62 of the laws of 2011, is amended to read as follows:
(2) A corporation desiring to increase or decrease premiums for any contract subject to this subsection shall submit a rate filing or application to the superintendent. A corporation shall send written notice of the proposed rate adjustment, [including the specific change requested,] to each contract holder and subscriber affected by the adjustment on or before the date the rate filing or application is submitted to the superintendent. The notice shall prominently include mailing and website addresses for both the department of financial services and the corporation through which a person may, within thirty days from the date the
A. 206 3
rate filing or application is submitted to the superintendent, contact the department of financial services or corporation to receive additional information or to submit written comments to the department of financial services on the rate filing or application. The superintendent shall establish a process to post on the department's website, in a timely manner, all relevant written comments received pertaining to rate filings or applications. The corporation shall provide a copy of the notice to the superintendent with the rate filing or application. The superintendent shall immediately cause the notice to be posted on the department of financial services' website. The superintendent shall determine whether the filing or application shall become effective as filed, shall become effective as modified, or shall be disapproved. The superintendent may modify or disapprove the rate filing or application if the superintendent finds that the premiums are unreasonable, excessive, inadequate, or unfairly discriminatory, and may consider the financial condition of the corporation in approving, modifying or disapproving any premium adjustment[. The]; provided, however, any adjustment to a rate filing or application must be in accordance with generally accepted actuarial principles and practices, and must be appropriate for the population to be covered and services to be furnished under the contract. An initial determination [of] regarding the rate of filing or application shall be made by the superintendent [shall be supported by sound actuarial assumptions and methods, and shall be rendered in writing between] no later than thirty [and sixty] days from the date the rate filing or application is submitted to the superintendent. The superintendent's initial determination shall be provided to a corporation in writing within the thirty day time period and shall describe in detail the actuarial assumptions and methods used in the superintendent's determination. Should the superintendent require additional information from the corporation in order to make [a] an initial determination, the superintendent shall require the corporation to furnish such information, and in such event, the [sixty] thirty days shall be tolled and shall resume as of the date the corporation furnishes the information to the superintendent. [If the superintendent requests additional information less than ten days from the expiration of the sixty days (exclusive of tolling), the superintendent may extend the sixty day period an additional twenty days, to make a determination. The] Following the issuance of the initial determination, a corporation shall have fifteen days to appeal the determination in writing. If an initial rate determination is appealed, the superintendent shall have fifteen days to issue a revised determination. If the initial determination is not appealed by a corporation, it shall become final fifteen days after it is issued. All final rate determinations shall be certified by an actuary designated by the superintendent who meets the qualification standards established by the American academy of actuaries and follow the practice standards established by the actuarial standards board. Notwithstanding the foregoing, the application or rate filing will be deemed approved if a determination is not rendered within the time allotted under this section. A corporation shall not implement a rate adjustment that is approved by the superintendent unless the corporation provides at least [sixty] thirty days advance [written] notice of the [premium rate adjustment approved by the superintendent] adjustment, either through a posting on its website or by written notice to each contract holder and subscriber affected by the rate adjustment.
§ 3. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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