S T A T E   O F   N E W   Y O R K
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                                  3781

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 28, 2009
                               ___________

Introduced by M. of A. KAVANAGH -- read once and referred to the Commit-
  tee on Insurance

AN ACT to amend the insurance law, in relation to genetic predisposition

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Subsection (a) of section  107  of  the  insurance  law  is
amended by adding a new paragraph 54 to read as follows:
  (54)  "GENETIC  PREDISPOSITION" SHALL MEAN THE PRESENCE OF A VARIATION
IN THE COMPOSITION OF THE GENES OF  AN  INDIVIDUAL  OR  AN  INDIVIDUAL'S
FAMILY  MEMBER  WHICH  IS  SCIENTIFICALLY  OR MEDICALLY IDENTIFIABLE AND
WHICH IS DETERMINED TO BE ASSOCIATED WITH AN INCREASED STATISTICAL  RISK
OF  BEING EXPRESSED AS EITHER A PHYSICAL OR MENTAL DISEASE OR DISABILITY
IN THE INDIVIDUAL OR HAVING  OFFSPRING  WITH  A  GENETICALLY  INFLUENCED
DISEASE,  BUT  WHICH HAS NOT RESULTED IN ANY SYMPTOMS OF SUCH DISEASE OR
DISORDER.
  S 2. Subsection (a) of section 3231 of the insurance law,  as  amended
by chapter 661 of the laws of 1997, is amended to read as follows:
  (a)  No  individual health insurance policy and no group health insur-
ance policy covering between two and fifty employees or members  of  the
group  exclusive of spouses and dependents, hereinafter referred to as a
small group, providing hospital and/or medical benefits, including medi-
care 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  imposi-
tion  of  a pre-existing condition limitation as permitted by this arti-
cle. Any individual, and dependents of such individual,  and  any  small
group,  including  all  employees  or  group  members  and dependents of
employees or members, applying for individual health insurance coverage,
including medicare supplemental coverage, or small group  health  insur-
ance  coverage,  including  medicare  supplemental  insurance,  must  be
accepted at all times  throughout  the  year  for  any  hospital  and/or

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06461-01-9
              

A. 3781                             2

medical  coverage  offered by the insurer to individuals or small groups
in this state. Once accepted for coverage, an individual or small  group
cannot  be  terminated  by  the insurer due to claims experience. Termi-
nation  of  an  individual  or small group shall be based only on one or
more of the reasons set forth in subsection (g) of section  three  thou-
sand two hundred sixteen or subsection (p) of section three thousand two
hundred twenty-one of this article. Group hospital and/or medical cover-
age,  including  medicare  supplemental  insurance,  obtained through an
out-of-state trust covering a group  of  fifty  or  fewer  employees  or
participating  persons who are residents of this state must be community
rated regardless of the situs of delivery of the policy. Notwithstanding
any other provisions of law, the underwriting of such policy may involve
no more than the imposition of a pre-existing  condition  limitation  as
permitted by this article, and once accepted for coverage, an individual
or  small  group  cannot  be terminated due to claims experience. Termi-
nation of an individual or small group shall be based  only  on  one  or
more  of  the reasons set forth in subsection (p) of section three thou-
sand two hundred twenty-one of this article.  For the purposes  of  this
section,  "community  rated"  means  a  rating  methodology in which the
premium for all persons covered by a policy or contract form is the same
based on the experience of the entire pool  of  risks  covered  by  that
policy  or  contract  form  without  regard  to age, sex, health status,
INCLUDING ANY GENETIC PREDISPOSITION, or occupation.
  S 3. The opening paragraph of subsection (b) of section  3232  of  the
insurance law, as amended by chapter 661 of the laws of 1997, is amended
to read as follows:
  No pre-existing condition provision shall exclude coverage for a peri-
od  in excess of twelve months following the enrollment date of coverage
for the covered person and may only relate to a condition (whether phys-
ical or mental), regardless of the cause of  the  condition,  for  which
medical advice, diagnosis, care or treatment was recommended or received
within  the  six-month period ending on the enrollment date.  NO PRE-EX-
ISTING CONDITION PROVISION SHALL EXCLUDE COVERAGE ON THE  BASIS  OF  ANY
GENETIC  PREDISPOSITION.  For purposes of this section "enrollment date"
means the first day of coverage of the individual under the  policy  or,
if  earlier,  the  first  day  of the waiting period that must pass with
respect to an individual  before  such  individual  is  eligible  to  be
covered for benefits. If an individual seeks and obtains coverage in the
individual  market,  any  period  after  the date the individual files a
substantially complete application for coverage and before the first day
of coverage is a waiting period. For purposes of  this  section  genetic
information  shall  not  be  treated  as a pre-existing condition in the
absence of a diagnosis of the condition related to such information.  No
pre-existing  condition  limitation  provision shall exclude coverage in
the case of:
  S 4. Subsection (a) of section 4317 of the insurance law,  as  amended
by chapter 661 of the laws of 1997, is amended to read as follows:
  (a) No individual health insurance contract and no group health insur-
ance contract covering between two and fifty employees or members of the
group 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  bene-
fits, 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 as

A. 3781                             3

permitted by this article.  Any individual, and dependents of such indi-
vidual, and any small group, including all employees  or  group  members
and dependents of employees or members, applying for individual or small
group health insurance coverage must be accepted at all times throughout
the  year  for  any hospital and/or medical coverage, including Medicare
supplemental insurance, offered by the  corporation  to  individuals  or
small groups in this state. Once accepted for coverage, an individual or
small  group  cannot  be terminated by the insurer due to claims experi-
ence. Termination of coverage for individuals or  small  groups  may  be
based  only on one or more of the reasons set forth in subsection (c) of
section four thousand three hundred four or subsection  (j)  of  section
four  thousand  three hundred five of this article.  For the purposes of
this section, "community rated" means a rating methodology in which  the
premium  for  all  persons  covered  by a policy or contract form is the
same, based on the experience of the entire pool  of  risks  covered  by
that  policy or contract form without regard to age, sex, health status,
INCLUDING ANY GENETIC PREDISPOSITION, or occupation.
  S 5. The opening paragraph of subsection (b) of section  4318  of  the
insurance law, as amended by chapter 661 of the laws of 1997, is amended
to read as follows:
  No pre-existing condition provision shall exclude coverage for a peri-
od  in  excess  of  twelve  months following the enrollment date for the
covered person and may only relate to a condition (whether  physical  or
mental),  regardless  of  the  cause  of the condition for which medical
advice, diagnosis, care or treatment was recommended or received  within
the  six  month  period  ending on the enrollment date.  For purposes of
this section "enrollment date" means the first day of  coverage  of  the
individual under the contract or, if earlier, the first day of the wait-
ing period that must pass with respect to an individual before the indi-
vidual  is  eligible  to be covered for benefits. If an individual seeks
and obtains coverage in the individual market, any period after the date
the individual files a substantially complete application  for  coverage
and  before  the first day of coverage is a waiting period. For purposes
of this section, genetic information shall not be treated as  a  pre-ex-
isting  condition in the absence of a diagnosis of the condition related
to such information.  NO PRE-EXISTING CONDITION PROVISION SHALL  EXCLUDE
COVERAGE  ON  THE  BASIS  OF ANY GENETIC PREDISPOSITION. No pre-existing
condition provision shall exclude coverage in the case of:
  S 6. This act shall take effect on the sixtieth  day  after  it  shall
have  become  a  law  and  shall  apply to all policies issued, renewed,
altered or modified on or after such date.