S T A T E O F N E W Y O R K
________________________________________________________________________
7113
2009-2010 Regular Sessions
I N A S S E M B L Y
March 20, 2009
___________
Introduced by M. of A. MORELLE -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the insurance law, in relation to the establishment of a
demonstration program to permit the issuance of a short term health
insurance policy or subscriber contract to recent college graduates
and other children losing coverage as a dependent under a parent's
policy; and providing for the repeal of such provisions upon the expi-
ration thereof
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subsection (l) of section 3216 of the insurance law, as
added by chapter 504 of the laws of 1995, is amended to read as follows:
(l) [On and after January first, nineteen hundred ninety-seven] EXCEPT
AS SET FORTH IN SECTION THREE THOUSAND TWO HUNDRED SIXTEEN-A OF THIS
ARTICLE, no insurer shall offer major medical, comprehensive or other
comparable individual contracts, other than for purposes of conversion,
unless the benefits of such contracts, including deductibles and coinsu-
rance, are identical to the out-of-plan benefits of the contracts
described in section four thousand three hundred twenty-two of this
chapter. Such contracts must include a prescription drug benefit comply-
ing with the requirements of that section.
S 2. The insurance law is amended by adding a new section 3216-a to
read as follows:
S 3216-A. SHORT-TERM HEALTH INSURANCE POLICIES. (A) DEFINITIONS. FOR
PURPOSES OF THIS SECTION:
1. "SHORT-TERM HEALTH INSURANCE POLICY" SHALL MEAN AN INDIVIDUAL
HEALTH INSURANCE POLICY THAT IS ISSUED FOR A DEFINED TERM NOT TO EXCEED
TWENTY-FOUR MONTHS.
2. "ELIGIBLE INDIVIDUAL" SHALL MEAN AN UNMARRIED INDIVIDUAL RESIDING
IN NEW YORK WHO (I) IS BETWEEN THE AGES OF NINETEEN AND TWENTY-SIX AND
(II) IS EITHER A RECENT GRADUATE OF A COLLEGE OR UNIVERSITY OR HAS
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07499-01-9
A. 7113 2
OTHERWISE LOST COVERAGE AS A DEPENDENT UNDER A PARENT'S POLICY AND (III)
IS NOT COVERED BY OR ELIGIBLE FOR ANY EMPLOYER-SPONSORED HEALTH BENEFITS
PLAN, WHETHER INSURED OR SELF-INSURED, EXCEPT THAT ELIGIBILITY FOR
CONTINUATION UNDER ANOTHER GROUP HEALTH PLAN SHALL NOT CONSTITUTE ELIGI-
BILITY FOR AN EMPLOYER-SPONSORED HEALTH BENEFIT PLAN FOR PURPOSES OF
THIS PARAGRAPH.
(B) AN INSURER SUBJECT TO THIS ARTICLE MAY ISSUE A SHORT-TERM HEALTH
INSURANCE POLICY TO AN ELIGIBLE INDIVIDUAL PROVIDED THAT:
1. THE POLICY INSURES THE ELIGIBLE INDIVIDUAL ON A COMMUNITY RATED AND
OPEN ENROLLMENT BASIS CONSISTENT WITH SECTION THREE THOUSAND TWO HUNDRED
THIRTY-ONE OF THIS ARTICLE. FOR PURPOSES OF THIS PARAGRAPH, THE COMMUNI-
TY RATE FOR THE POLICY IS TO BE BASED SOLELY ON THE ENTIRE POOL OF RISKS
COVERED BY THE POLICY.
2. NOTWITHSTANDING THE REQUIREMENTS OF SUBSECTION (G) OF SECTION THREE
THOUSAND TWO HUNDRED SIXTEEN OF THIS ARTICLE, THE POLICY IS NONRENEWABLE
AND ALL BENEFITS WILL END UPON TERMINATION OF THE POLICY, SUBJECT TO ANY
EXTENSION OF BENEFITS REQUIRED BY INSURANCE REGULATION.
3. AT A MINIMUM, THE POLICY PROVIDES COVERAGE FOR THE FOLLOWING
SERVICES:
(I) INPATIENT HOSPITAL SERVICES, CONSISTING OF DAILY ROOM AND BOARD
AND MISCELLANEOUS HOSPITAL SERVICES PROVIDED BY A SHORT-TERM ACUTE CARE
GENERAL HOSPITAL;
(II) OUTPATIENT HOSPITAL SERVICES CONSISTING OF OUTPATIENT SURGERY
SERVICES AND X-RAY AND LABORATORY TESTS PERFORMED IN THE OUTPATIENT
DEPARTMENT OF A HOSPITAL;
(III) PHYSICIAN OFFICE VISITS;
(IV) PREADMISSION TESTING;
(V) TREATMENT OF AN EMERGENCY CONDITION IN HOSPITAL FACILITIES;
(VI) UP TO FORTY VISITS FOR HOME CARE SERVICES PROVIDED TO A COVERED
PERSON IN LIEU OF HOSPITALIZATION;
(VII) SURGICAL SERVICES, CONSISTING OF OPERATING AND CUTTING PROCE-
DURES FOR THE TREATMENT OF A SICKNESS OR INJURY AND ENDOSCOPIC PROCE-
DURES, INCLUDING ANY PRE- AND POST-OPERATIVE CARE AND ANESTHETIC
SERVICES;
(VIII) SECOND SURGICAL OPINION;
(IX) DIAGNOSTIC RADIOLOGY AND LABORATORY SERVICES;
(X) CERVICAL CYTOLOGY SCREENING; AND
(XI) ONE ROUTINE PHYSICAL.
4. THE POLICY IMPOSES NO DEDUCTIBLE IN EXCESS OF TWO THOUSAND FIVE
HUNDRED DOLLARS PER CALENDAR OR CONTRACT YEAR, NO COINSURANCE IN EXCESS
OF FIFTY PERCENT OR, IN LIEU OF COINSURANCE, NO COPAYMENT GREATER THAN
FORTY DOLLARS PER SERVICE. THE ROUTINE PHYSICAL EXAMINATION SHALL NOT BE
SUBJECT TO A DEDUCTIBLE.
5. IF THE POLICY HAS A PREEXISTING CONDITION PROVISION, THE PROVISION
MUST COMPLY WITH SECTION THREE THOUSAND TWO HUNDRED THIRTY-TWO OF THIS
ARTICLE, INCLUDING THE REQUIREMENTS THAT CREDIT BE APPLIED TOWARD ANY
WAITING PERIOD FOR THE PERIOD OF TIME THE ELIGIBLE INDIVIDUAL WAS
COVERED BY CREDITABLE COVERAGE, PROVIDED THAT THE COVERAGE WAS CONTIN-
UOUS TO A DATE NOT MORE THAN SIXTY-THREE DAYS PRIOR TO THE ENROLLMENT
DATE OF THE SHORT-TERM HEALTH INSURANCE POLICY.
S 3. Subsection (l) of section 4304 of the insurance law, as added by
chapter 504 of the laws of 1995, is amended to read as follows:
(l) [On and after January first, nineteen hundred ninety-seven] EXCEPT
AS SET FORTH IN SECTION FOUR THOUSAND THREE HUNDRED FOUR-A OF THIS ARTI-
CLE, no insurer shall offer major medical, comprehensive or other compa-
rable individual contracts on a direct payment basis, other than for
A. 7113 3
purposes of conversion, unless the benefits of such contracts, including
deductibles and coinsurance, are identical to the out-of-plan benefits
of the contracts described in section four thousand three hundred twen-
ty-two of this article. Such contracts must include a prescription drug
benefit complying with the requirements of such section.
S 4. The insurance law is amended by adding a new section 4304-a to
read as follows:
S 4304-A. SHORT-TERM SUBSCRIBER CONTRACTS. (A) DEFINITIONS. FOR
PURPOSES OF THIS SECTION:
1. "SHORT-TERM SUBSCRIBER CONTRACT" SHALL MEAN AN INDIVIDUAL SUBSCRIB-
ER CONTRACT THAT IS ISSUED FOR A DEFINED TERM NOT TO EXCEED TWENTY-FOUR
MONTHS.
2. "ELIGIBLE INDIVIDUAL" SHALL MEAN AN UNMARRIED INDIVIDUAL RESIDING
IN NEW YORK WHO (I) IS BETWEEN THE AGES OF NINETEEN AND TWENTY-SIX AND
(II) IS EITHER A RECENT GRADUATE OF A COLLEGE OR UNIVERSITY OR HAS
OTHERWISE LOST COVERAGE AS A DEPENDENT UNDER A PARENT'S POLICY AND (III)
IS NOT COVERED BY OR ELIGIBLE FOR ANY EMPLOYER-SPONSORED HEALTH BENEFITS
PLAN, WHETHER INSURED OR SELF-INSURED, EXCEPT THAT ELIGIBILITY FOR
CONTINUATION UNDER ANOTHER GROUP HEALTH PLAN SHALL NOT CONSTITUTE ELIGI-
BILITY FOR AN EMPLOYER-SPONSORED HEALTH BENEFIT PLAN FOR PURPOSES OF
THIS PARAGRAPH.
(B) A HOSPITAL SERVICE CORPORATION, MEDICAL EXPENSE INDEMNITY CORPO-
RATION OR A HEALTH SERVICE CORPORATION SUBJECT TO THIS ARTICLE MAY ISSUE
A SHORT-TERM SUBSCRIBER CONTRACT TO AN ELIGIBLE INDIVIDUAL PROVIDED
THAT:
1. THE CONTRACT INSURES THE ELIGIBLE INDIVIDUAL ON A COMMUNITY RATED
AND OPEN ENROLLMENT BASIS CONSISTENT WITH SECTION FOUR THOUSAND THREE
HUNDRED SEVENTEEN OF THIS ARTICLE. FOR PURPOSES OF THIS PARAGRAPH, THE
COMMUNITY RATE FOR THE CONTRACT IS TO BE BASED SOLELY ON THE ENTIRE POOL
OF RISKS COVERED BY THE CONTRACT.
2. NOTWITHSTANDING THE REQUIREMENTS OF SUBSECTION (B) OF SECTION FOUR
THOUSAND THREE HUNDRED FOUR OF THIS ARTICLE, THE CONTRACT IS NONRENEWA-
BLE AND ALL BENEFITS WILL END UPON TERMINATION OF THE CONTRACTS, SUBJECT
TO ANY EXTENSION OF BENEFITS REQUIRED BY INSURANCE REGULATION.
3. AT A MINIMUM, THE CONTRACT PROVIDES COVERAGE FOR THE FOLLOWING
SERVICES:
(I) INPATIENT HOSPITAL SERVICES, CONSISTING OF DAILY ROOM AND BOARD
AND MISCELLANEOUS HOSPITAL SERVICES PROVIDED BY A SHORT TERM ACUTE CARE
GENERAL HOSPITAL;
(II) OUTPATIENT HOSPITAL SERVICES, CONSISTING OF OUTPATIENT SURGERY
SERVICES AND X-RAY AND LABORATORY TESTS PERFORMED IN THE OUTPATIENT
DEPARTMENT OF A HOSPITAL;
(III) PHYSICIAN OFFICE VISITS;
(IV) PREADMISSION TESTING;
(V) TREATMENT OF AN EMERGENCY CONDITION IN HOSPITAL FACILITIES;
(VI) UP TO FORTY VISITS FOR HOME CARE SERVICES PROVIDED TO A COVERED
PERSON IN LIEU OF HOSPITALIZATION;
(VII) SURGICAL SERVICES;
(VIII) SECOND SURGICAL OPINION;
(IX) DIAGNOSTIC RADIOLOGY AND LABORATORY SERVICES;
(X) CERVICAL CYTOLOGY SCREENING; AND
(XI) ONE ROUTINE PHYSICAL EXAMINATION.
4. THE CONTRACT IMPOSES NO DEDUCTIBLE IN EXCESS OF TWO THOUSAND FIVE
HUNDRED DOLLARS PER CALENDAR OR CONTRACT YEAR, NO COINSURANCE IN EXCESS
OF FIFTY PERCENT OR, IN LIEU OF COINSURANCE, NO COPAYMENT GREATER THAN
A. 7113 4
FORTY DOLLARS PER SERVICE. THE ROUTINE PHYSICAL EXAMINATION SHALL NOT BE
SUBJECT TO A DEDUCTIBLE.
5. IF THE CONTRACT HAS A PREEXISTING CONDITION PROVISION, THE
PROVISION MUST COMPLY WITH SECTION FOUR THOUSAND THREE HUNDRED EIGHTEEN
OF THIS ARTICLE, INCLUDING THE REQUIREMENTS THAT CREDIT BE APPLIED
TOWARD ANY WAITING PERIOD FOR THE PERIOD OF TIME THE ELIGIBLE INDIVIDUAL
WAS COVERED BY CREDITABLE COVERAGE, PROVIDED THAT THE COVERAGE WAS
CONTINUOUS TO A DATE NOT MORE THAN SIXTY-THREE DAYS PRIOR TO THE ENROLL-
MENT DATE OF THE SHORT-TERM SUBSCRIBER CONTRACT.
S 5. On or before April 1, 2014, the superintendent of insurance shall
report to the governor, the temporary president of the senate, the
speaker of the assembly and to the chairs of the insurance committees of
the senate and the assembly on the effectiveness of the short-term
health insurance policies and subscriber contracts for addressing the
problem of young adults who find themselves uninsured as a result of
graduation or losing dependent status under a parent's coverage and who
need temporary coverage until they can obtain employer-sponsored cover-
age. Such report shall also contain any recommendations as to whether
to extend the provisions of this act beyond its expiration.
S 6. This act shall take effect immediately and shall expire and be
deemed repealed on December 31, 2014.