|
Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
|---|---|
| Jan 06, 2010 |
referred to insurance |
| Mar 10, 2009 |
referred to insurance |
Senate Bill S3092
2009-2010 Legislative Session
Relates to establishment of "freedom health insurance plans"
download bill text pdfSponsored By
(D, IP) Senate District
Archive: Last Bill Status - In Senate Committee Insurance Committee
- Introduced
-
- In Committee Assembly
- In Committee Senate
-
- On Floor Calendar Assembly
- On Floor Calendar Senate
-
- Passed Assembly
- Passed Senate
- Delivered to Governor
- Signed By Governor
Actions
2009-S3092 (ACTIVE) - Details
- See Assembly Version of this Bill:
- A2197
- Current Committee:
- Senate Insurance
- Law Section:
- Insurance Law
- Laws Affected:
- Amd Ins L, generally; amd §§210, 606, 1456 & 1511, Tax L; amd §§4401 & 4406, Pub Health L
- Versions Introduced in 2011-2012 Legislative Session:
-
A4106
2009-S3092 (ACTIVE) - Summary
Relates to establishment of "freedom health insurance plans"; provides a tax credit for certain health insurance plans purchased by small employers and certain individuals; provides additional payments to HMO's from the direct payment stop loss fund; amends certain enrollment and rate provisions.
2009-S3092 (ACTIVE) - Sponsor Memo
BILL NUMBER: S3092
TITLE OF BILL :
An act to amend the insurance law, in relation to establishment of
freedom health insurance plans; to amend the tax law, in relation to
providing a tax credit for the purchase of certain health insurance;
and to amend the public health law, in relation to the health
maintenance organization direct pay market program
PURPOSE :
Approximately 3 million residents of New York State are uninsured.
Health insurance premium increases in excess of ten per cent are
regularly occurring and increasing health care costs are expected to
continue. New York State is expected to spend almost $9 billion in the
2003-2004 fiscal year to pay for the cost of providing health care for
the uninsured and for programs to provide health care coverage.
This legislation provides a multiple approach strategy to reduce the
number of uninsured and help people afford health insurance. It uses
the private market, tax advantages and state subsidy of the commercial
market to bring health insurance within the potential means of every
New Yorker.
SUMMARY OF PROVISIONS :
Sections 1 through 5 amend sections 3216, 3221, 4304 and 4322 of the
insurance law to authorize HMOs and insurers to offer new "Freedom policies." These policies would cost approximately 40% less than existing policies, have higher deductibles, and be coupled with new Health Savings Accounts (HSAs). Health Savings Accounts are tax free, portable accounts used to pay out-of-pocket expenses. Freedom policies would be mandate free, giving choice of benefits and providers. They would be eligible for proposed federal tax deductions and state tax credits. Sections 6 through 11 amend sections 210, 606, 1456 and 1511 of the tax law, providing small businesses of fifty employees or less and individuals purchasing their own insurance a state tax credit equal to 50% of the cost of health insurance premiums. The tax credits would be phased in over a ten year period. Sections 12 through 14 amend section 4326 of the insurance law to expand the Healthy NY program by increasing income eligibility for individual purchasers from 208% of the federal poverty level to 250% of the federal poverty level, and allowing persons with incomes over 250% of the federal poverty level to purchase a Healthy NY policy at the actuarial price, without the stop loss subsidy. Sections 15 through 18 and Section 25 amend sections 4327, 4321-a, 4322-a and 2406 of the insurance law to enhance the small group and direct pay market stop loss pools by adding $31 million to reimburse claims up to the statutory level and to create a new catastrophic stop loss fund for claims in the individual market above $500,000. Penalties collected from violations of the prompt pay law would be deposited in stop loss pools. Sections 19 tough 23 amend sections 3231 and 4317 of the insurance law and section 4401 of the public health law relating to rating of similar products in the small group market and adverse selection in the large group market. The bill would allow similar, but different policies with in a community pool to be rated separately. It also gives health maintenance organizations the same ability as insurers to establish minimum participation levels for large group policies. JUSTIFICATION : The commercial market has become increasingly expensive and offers little choice of benefit design or pricing flexibility. Without reform, the individual and small group market in New York State will become unsustainable. The sponsors believe that the private market should be preserved through a reformed model which transitions from first dollar coverage to more traditional insurance, offers policy design and benefit choices, and ensures access to preventive, primary and acute care. The federal Medicare reform law signed in December of 2003, established Health Savings Accounts (HSAs) which must be coupled with a health insurance policy that has at least a $1,000 deductible for individuals and $2,000 for family coverage. Authorization of such policies in New York, free of benefit mandates, would allow a range of coverage options and opportunities combined with funds from an HSA. The consumer is assured protection from costly health risk and has access to funds to pay for care from any provider which is not covered by the policy. Tax credits for businesses offer an incentive to provide coverage and will help prevent shifting costs to employees. A credit for individuals purchasing their own coverage will help reduce net cost of coverage. The Healthy NY program offers a two pronged approach towards affordability: 1) a streamlined benefit package that maintains coverage for essential, primary. preventive and acute services, with a prescription drug option, and; 2) state subsidization of costs through a stop loss program which reimburses plans for high cost claims. Expansion of the program is possible through existing program funds and would make this affordable program available to more people. Providing rating flexibility while maintaining community rating principles will provide lower cost and incentive for efficiently designed and managed policies and will prevent negative effects of adverse selection. Taken together, these measures represent a comprehensive, multi-facet approach towards ensuring that people in New York can afford health insurance and have access to the care that they need. The bill gives people choices and access to coverage and care. It offers tax advantages and uses state funds to give people real health care. It preserves the private market and protects those who need health care most. LEGISLATIVE HISTORY : 2003-04: A.10251/S.6332 (Passed Senate) 2005-06: A.2688 2007-08: A.2524 FISCAL IMPLICATIONS : The tax credit provisions of the bill would cost approximately $1.6 billion per year when fully implemented. EFFECTIVE DATE : The bill would take effect on the proceeding first of January, however, the tax credits would be phased in over ten years.
2009-S3092 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K
________________________________________________________________________
3092
2009-2010 Regular Sessions
I N S E N A T E
March 10, 2009
___________
Introduced by Sen. VALESKY -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to establishment of free-
dom health insurance plans; to amend the tax law, in relation to
providing a tax credit for the purchase of certain health insurance;
and to amend the public health law, in relation to the health mainte-
nance organization direct pay market program
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, 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 coinsurance, 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 complying with the
requirements of that section. THE REQUIREMENTS OF THIS SUBSECTION SHALL
NOT APPLY TO A POLICY INTENDED TO QUALIFY FOR USE IN A HEALTH SAVINGS
ACCOUNT PURSUANT TO SECTION 1201 OF THE FEDERAL MEDICARE PRESCRIPTION
DRUG, IMPROVEMENT AND MODERNIZATION ACT OF 2003. SUCH POLICIES SHALL BE
KNOWN AS "FREEDOM POLICIES".
S 2. Section 3221 of the insurance law is amended by adding a new
subsection (r) to read as follows:
(R) NO GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICY ISSUED OR
ISSUED FOR DELIVERY IN THIS STATE FOR USE IN A HEALTH SAVINGS ACCOUNT
PURSUANT TO SECTION 1201 OF THE FEDERAL MEDICARE PRESCRIPTION DRUG,
IMPROVEMENT, AND MODERNIZATION ACT OF 2003 SHALL BE REQUIRED TO MEET THE
REQUIREMENTS OF THIS SECTION, OR REGULATIONS ISSUED BY THE SUPERINTEN-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04920-01-9
S. 3092 2
DENT, WITH REGARD TO COVERED HEALTH CARE SERVICES WHICH MUST BE INCLUDED
IN THE POLICY. SUCH POLICIES SHALL BE KNOWN AS "FREEDOM POLICIES".
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, no
insurer shall offer major medical, comprehensive or other comparable
individual contracts on a direct payment basis, other than for purposes
of conversion, unless the benefits of such contracts, including deduct-
ibles and coinsurance, are identical to the out-of-plan benefits of the
contracts described in section four thousand three hundred twenty-two of
this article. Such contracts must include a prescription drug benefit
complying with the requirements of such section. THE REQUIREMENTS OF
THIS SUBSECTION SHALL NOT APPLY TO A POLICY INTENDED TO QUALIFY FOR USE
IN A HEALTH SAVINGS ACCOUNT PURSUANT TO SECTION 1201 OF THE FEDERAL
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT AND MODERNIZATION ACT OF 2003.
SUCH POLICIES SHALL BE KNOWN AS "FREEDOM POLICIES".
S 4. Section 4304 of the insurance law is amended by adding a new
subsection (m) to read as follows:
(M) NO POLICY ISSUED TO A REMITTING AGENT ON BEHALF OF A GROUP PURSU-
ANT TO SUBSECTION (A) OF THIS SECTION, AND NO POLICY ISSUED TO A GROUP
PURSUANT TO SECTION FOUR THOUSAND THREE HUNDRED FIVE OF THIS ARTICLE,
FOR USE IN A HEALTH SAVINGS ACCOUNT PURSUANT TO SECTION 1201 OF THE
FEDERAL MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT
OF 2003 SHALL BE REQUIRED TO MEET THE REQUIREMENTS OF THIS SECTION OR
SECTION FOUR THOUSAND THREE HUNDRED FIVE OF THIS ARTICLE, OR REGULATIONS
ISSUED BY THE SUPERINTENDENT, WITH REGARD TO COVERED HEALTH CARE
SERVICES WHICH MUST BE INCLUDED IN THE POLICY. SUCH POLICIES SHALL BE
KNOWN AS "FREEDOM POLICIES".
S 5. Subsection (a) of section 4322 of the insurance law, as amended
by chapter 342 of the laws of 2004, is amended to read as follows:
(a) On and after January first, nineteen hundred ninety-six, all
health maintenance organizations issued a certificate of authority under
article forty-four of the public health law or licensed under this arti-
cle shall offer to individuals, in addition to the standardized contract
required by section four thousand three hundred twenty-one of this arti-
cle, a standardized individual enrollee direct payment contract on an
open enrollment basis as prescribed by section four thousand three
hundred seventeen of this article and section four thousand four hundred
six of the public health law, and regulations promulgated thereunder,
with an out-of-plan benefit system, provided, however, that such
requirements shall not apply to a health maintenance organization exclu-
sively serving individuals enrolled pursuant to title eleven of article
five of the social services law, title eleven-D of article five of the
social services law, title one-A of article twenty-five of the public
health law or title eighteen of the federal Social Security Act, and,
further provided, that such health maintenance organization shall not
discontinue a contract for an individual receiving comprehensive-type
coverage in effect prior to January first, two thousand four who is
ineligible to purchase policies offered after such date pursuant to this
section or section four thousand three hundred [twenty-two] TWENTY-ONE
of this article due to the provision of 42 U.S.C. 1395ss in effect prior
to January first, two thousand four. The out-of-plan benefit system
shall either be provided by the health maintenance organization pursuant
to subdivision two of section four thousand four hundred six of the
public health law or through an accompanying insurance contract provid-
ing out-of-plan benefits offered by a company appropriately licensed
S. 3092 3
pursuant to this chapter. On and after January first, nineteen hundred
ninety-six, the contracts issued pursuant to this section and section
four thousand three hundred twenty-one of this article shall be the only
contracts offered by health maintenance organizations to individuals;
PROVIDED, HOWEVER, THIS LIMITATION SHALL NOT APPLY TO ONE OR MORE POLI-
CIES INTENDED TO QUALIFY FOR USE IN A HEALTH SAVINGS ACCOUNT PURSUANT TO
SECTION 1201 OF THE FEDERAL MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND
MODERNIZATION ACT OF 2003. SUCH POLICIES SHALL BE KNOWN AS "FREEDOM
POLICIES". The enrollee contracts issued by a health maintenance organ-
ization under this section and section four thousand three hundred twen-
ty-one of this article shall also be the only contracts issued by the
health maintenance organization for purposes of conversion pursuant to
sections four thousand three hundred four and four thousand three
hundred five of this article. However, nothing in this section shall be
deemed to require health maintenance organizations to terminate individ-
ual direct payment contracts issued prior to January first, nineteen
hundred ninety-six or prohibit health maintenance organizations from
terminating individual direct payment contracts issued prior to January
first, nineteen hundred ninety-six.
S 6. Section 210 of the tax law is amended by adding a new subdivision
41 to read as follows:
41. (A) A TAXPAYER WHO IS A QUALIFIED SMALL EMPLOYER SHALL BE ALLOWED
A CREDIT AGAINST THE TAX IMPOSED BY THIS ARTICLE EQUAL TO THE APPLICABLE
PERCENTAGE OF PREMIUMS PAID DURING THE TAXABLE YEAR FOR HEALTH INSURANCE
BY SUCH EMPLOYER. THE APPLICABLE PERCENTAGE SHALL BE (I) FIVE PERCENT
FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND
NINE, (II) TEN PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND TEN, (III) FIFTEEN PERCENT FOR TAXABLE YEARS BEGIN-
NING ON OR AFTER JANUARY FIRST, TWO THOUSAND ELEVEN, (IV) TWENTY PERCENT
FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND
TWELVE, (V) TWENTY-FIVE PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER
JANUARY FIRST, TWO THOUSAND THIRTEEN, (VI) THIRTY PERCENT FOR TAXABLE
YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, (VII)
THIRTY-FIVE PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND FIFTEEN, (VIII) FORTY PERCENT FOR TAXABLE YEARS
BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND SIXTEEN, AND (IX)
FORTY-THREE PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND SEVENTEEN.
(B) THE CREDIT ALLOWED UNDER THIS SUBDIVISION FOR ANY YEAR SHALL NOT
REDUCE THE TAX DUE FOR SUCH YEAR TO LESS THAN THE HIGHER OF THE AMOUNTS
PRESCRIBED IN PARAGRAPHS (C) AND (D) OF SUBDIVISION ONE OF THIS SECTION.
IF, HOWEVER, THE AMOUNT OF CREDIT ALLOWABLE UNDER THIS SUBDIVISION FOR
ANY TAXABLE YEAR REDUCES THE TAX TO SUCH AMOUNT, ANY AMOUNT OF CREDIT
NOT DEDUCTIBLE IN SUCH TAXABLE YEAR MAY BE CARRIED OVER TO THE FOLLOWING
YEAR OR YEARS AND MAY BE DEDUCTED FROM THE TAXPAYER'S TAX FOR SUCH YEAR
OR YEARS.
(C) FOR THE PURPOSES OF THIS SUBDIVISION "QUALIFIED SMALL EMPLOYER"
SHALL MEAN AN INDIVIDUAL PROPRIETOR WHO IS THE SOLE EMPLOYEE OF THE
BUSINESS OR AN EMPLOYER WITH NOT MORE THAN FIFTY EMPLOYEES WHO IS A
"SMALL BUSINESS TAXPAYER" AS DEFINED IN PARAGRAPH (F) OF SUBDIVISION ONE
OF THIS SECTION.
(D) FOR THE PURPOSES OF THIS SUBDIVISION, THE TERM "HEALTH INSURANCE"
MEANS AN ACCIDENT AND HEALTH INSURANCE POLICY SUBJECT TO THE PROVISIONS
OF SECTION THREE THOUSAND TWO HUNDRED SIXTEEN, THREE THOUSAND TWO
HUNDRED TWENTY-ONE, FOUR THOUSAND THREE HUNDRED THREE OR FOUR THOUSAND
EIGHT HUNDRED ONE OF THE INSURANCE LAW, AND ARTICLE FORTY-FOUR OF THE
S. 3092 4
PUBLIC HEALTH LAW AND SHALL INCLUDE "FREEDOM POLICIES" WHICH QUALIFY FOR
USE IN A HEALTH SAVINGS ACCOUNT PURSUANT TO SECTION 1201 OF THE FEDERAL
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT AND MODERNIZATION ACT OF 2003.
S 7. Subparagraph (B) of paragraph 1 of subsection (i) of section 606
of the tax law, as amended by section 2 of part ZZ1 of chapter 57 of the
laws of 2008, is amended to read as follows:
(B) shall be treated as the owner of a new business with respect to
such share if the corporation qualifies as a new business pursuant to
paragraph (j) of subdivision twelve of section two hundred ten of this
chapter.
The corporation's credit base under
section two hundred ten or section
With respect to the following fourteen hundred fifty-six of this
credit under this section: chapter is:
(I) Investment tax credit Investment credit base
under subsection (a) or qualified
rehabilitation
expenditures under
subdivision twelve of
section two hundred ten
(II) Empire zone Cost or other basis
investment tax credit under subdivision
under subsection (j) twelve-B
of section two hundred
ten
(III) Empire zone Eligible wages under
wage tax credit subdivision nineteen of
under subsection (k) section two hundred ten
or subsection (e) of
section fourteen hundred
fifty-six
(IV) Empire zone Qualified investments
capital tax credit and contributions under
under subsection (l) subdivision twenty of
section two hundred ten
or subsection (d) of
section fourteen hundred
fifty-six
(V) Agricultural property tax Allowable school
credit under subsection (n) district property taxes under
subdivision twenty-two of
section two hundred ten
(VI) Credit for employment Qualified first-year wages or
of persons with dis- qualified second-year wages
abilities under under subdivision
subsection (o) twenty-three of section
two hundred ten
or subsection (f)
of section fourteen
S. 3092 5
hundred fifty-six
(VII) Employment incentive Applicable investment credit
credit under subsec- base under subdivision
tion (a-1) twelve-D of section two
hundred ten
(VIII) Empire zone Applicable investment
employment credit under sub-
incentive credit under division twelve-C
subsection (j-1) of section two hundred ten
(IX) Alternative fuels credit Cost under subdivision
under subsection (p) twenty-four of section two
hundred ten
(X) Qualified emerging Applicable credit base
technology company under subdivision twelve-E
employment credit of section two hundred ten
under subsection (q)
(XI) Qualified emerging Qualified investments under
technology company subdivision twelve-F of
capital tax credit section two hundred ten
under subsection (r)
(XII) Credit for purchase of an Cost of an automated
automated external defibrillator external defibrillator under
under subsection (s) subdivision twenty-five of
section two hundred ten
or subsection (j) of section
fourteen hundred fifty-six
(XIII) Low-income housing Credit amount under
credit under subsection (x) subdivision thirty
of section two hundred ten or
subsection (l) of section
fourteen hundred fifty-six
(XIV) Credit for transportation Amount of credit under sub-
improvement contributions division thirty-two of section
under subsection (z) two hundred ten or subsection
(n) of section fourteen
hundred fifty-six
(XV) QEZE credit for real property Amount of credit under
taxes under subsection (bb) subdivision twenty-seven of
section two hundred ten or
subsection (o) of section
fourteen hundred fifty-six
(XVI) QEZE tax reduction credit Amount of benefit period
under subsection (cc) factor, employment increase factor
and zone allocation
factor (without regard
to pro ration) under
S. 3092 6
subdivision twenty-eight of
section two hundred ten or
subsection (p) of section
fourteen hundred fifty-six
and amount of tax factor
as determined under
subdivision (f) of section sixteen
(XVII) Green building credit Amount of green building credit
under subsection (y) under subdivision thirty-one
of section two hundred ten
or subsection (m) of section
fourteen hundred fifty-six
(XVIII) Credit for long-term Qualified costs under
care insurance premiums subdivision twenty-five-a of
under subsection (aa) section two hundred ten
or subsection (k) of section
fourteen hundred fifty-six
(XIX) Brownfield redevelopment Amount of credit
credit under subsection under subdivision
(dd) thirty-three of section
two hundred ten
or subsection (q) of
section fourteen hundred
fifty-six
(XX) Remediated brownfield Amount of credit under
credit for real property subdivision thirty-four
taxes for qualified of section two hundred
sites under subsection ten or subsection (r) of
(ee) section fourteen hundred
fifty-six
(XXI) Environmental Amount of credit under
remediation subdivision thirty-five of
insurance credit under section two hundred
subsection (ff) ten or subsection
(s) of section
fourteen hundred
fifty-six
(XXII) Empire state film production Amount of credit for
qualified
credit under subsection (gg) production costs in production
of a qualified film under
subdivision thirty-six of
section two hundred ten
(XXIII) Qualified emerging Qualifying expenditures and
technology company facilities, development activities under
operations and training credit subdivision twelve-G of section
under subsection (nn) two hundred ten
S. 3092 7
(XXIV) Security training tax Amount of credit
credit under under subdivision thirty-seven
subsection (ii) of section two hundred ten or
under subsection (t) of
section fourteen hundred fifty-six
(XXV) Credit for qualified fuel Amount of credit under
cell electric generating equipment subdivision thirty-seven
expenditures under subsection (g-2) of section two hundred ten
or subsection (t) of
section fourteen hundred
fifty-six
(XXVI) Empire state commercial Amount of credit for
production credit qualified production costs in
under subsection (jj) production of a qualified commercial
under subdivision thirty-eight
of section two hundred ten
(XXVII) Biofuel production Amount of credit
tax credit under under subdivision
subsection (jj) thirty-eight of
section two hundred ten
(XXVIII) Clean heating fuel Amount of credit under
credit under subsection (mm) subdivision thirty-nine of
section two hundred ten
(XXIX) Credit for rehabilitation Amount of credit under
of historic properties subdivision forty of
under subsection (oo) [subsection] SECTION two hundred ten
(XXX) Credit for companies who Amount of credit under
provide transportation subdivision forty of
to individuals section two hundred ten
with disabilities
under subsection (oo)
(XXXI) SMALL EMPLOYER HEALTH CREDIT UNDER SUBDIVISION
CARE INSURANCE CREDIT FORTY-ONE OF SECTION TWO
UNDER SUBSECTION (QQ) HUNDRED TEN
S 8. Section 606 of the tax law is amended by adding a new subsection
(qq) to read as follows:
(QQ) SMALL EMPLOYER HEALTH CARE INSURANCE CREDIT. (1) A TAXPAYER WHO
IS A QUALIFIED SMALL EMPLOYER SHALL BE ALLOWED A CREDIT AGAINST THE TAX
IMPOSED BY THIS ARTICLE EQUAL TO THE APPLICABLE PERCENTAGE OF THE PREMI-
UMS PAID DURING THE TAXABLE YEAR FOR HEALTH INSURANCE BY SUCH EMPLOYER.
THE APPLICABLE PERCENTAGE SHALL BE (A) FIVE PERCENT FOR TAXABLE YEARS
BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND NINE, (B) TEN PERCENT
FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND TEN,
(C) FIFTEEN PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND ELEVEN, (D) TWENTY PERCENT FOR TAXABLE YEARS BEGIN-
NING ON OR AFTER JANUARY FIRST, TWO THOUSAND TWELVE, (E) TWENTY-FIVE
PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOU-
SAND THIRTEEN, (F) THIRTY PERCENT FOR TAXABLE YEARS BEGINNING ON OR
AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN, (G) THIRTY-FIVE PERCENT FOR
S. 3092 8
TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND FIFTEEN,
(H) FORTY PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST,
TWO THOUSAND SIXTEEN, AND (I) FORTY-THREE PERCENT FOR TAXABLE YEARS
BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND SEVENTEEN. IF THE
AMOUNT OF THE CREDIT ALLOWABLE UNDER THIS SUBSECTION FOR ANY TAXABLE
YEAR SHALL EXCEED THE TAXPAYER'S TAX FOR SUCH YEAR, THE EXCESS MAY BE
CARRIED OVER TO THE FOLLOWING YEAR OR YEARS AND MAY BE DEDUCTED FROM THE
TAXPAYER'S TAX FOR SUCH YEAR OR YEARS.
(2) FOR THE PURPOSES OF THIS SUBSECTION "QUALIFIED SMALL EMPLOYER"
SHALL MEAN AN INDIVIDUAL PROPRIETOR WHO IS THE SOLE EMPLOYEE OF THE
BUSINESS OR AN EMPLOYER WITH NOT MORE THAN FIFTY EMPLOYEES WHO IS A
"SMALL BUSINESS TAXPAYER" AS DEFINED IN PARAGRAPH (F) OF SUBDIVISION ONE
OF SECTION TWO HUNDRED TEN OF THIS CHAPTER.
(3) FOR THE PURPOSES OF THIS SUBSECTION, THE TERM "HEALTH INSURANCE"
MEANS AN ACCIDENT AND HEALTH INSURANCE POLICY SUBJECT TO THE PROVISIONS
OF SECTION THREE THOUSAND TWO HUNDRED SIXTEEN, THREE THOUSAND TWO
HUNDRED TWENTY-ONE, FOUR THOUSAND THREE HUNDRED THREE OR FOUR THOUSAND
EIGHT HUNDRED ONE OF THE INSURANCE LAW, AND ARTICLE FORTY-FOUR OF THE
PUBLIC HEALTH LAW AND SHALL INCLUDE "FREEDOM POLICIES" WHICH QUALIFY FOR
USE IN A HEALTH SAVINGS ACCOUNT PURSUANT TO SECTION 1201 OF THE FEDERAL
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT AND MODERNIZATION ACT OF 2003.
S 9. Section 1456 of the tax law is amended by adding a new subsection
(f-1) to read as follows:
(F-1)(1) A TAXPAYER WHO IS A QUALIFIED SMALL EMPLOYER SHALL BE ALLOWED
A CREDIT AGAINST THE TAX IMPOSED BY THIS ARTICLE EQUAL TO THE APPLICABLE
PERCENTAGE OF THE PREMIUMS PAID DURING THE TAXABLE YEAR FOR HEALTH
INSURANCE BY SUCH EMPLOYER. THE APPLICABLE PERCENTAGE SHALL BE (A) FIVE
PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOU-
SAND NINE, (B) TEN PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANU-
ARY FIRST, TWO THOUSAND TEN, (C) FIFTEEN PERCENT FOR TAXABLE YEARS
BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND ELEVEN, (D) TWENTY
PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOU-
SAND TWELVE, (E) TWENTY-FIVE PERCENT FOR TAXABLE YEARS BEGINNING ON OR
AFTER JANUARY FIRST, TWO THOUSAND THIRTEEN, (F) THIRTY PERCENT FOR TAXA-
BLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND FOURTEEN,
(G) THIRTY-FIVE PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND FIFTEEN, (H) FORTY PERCENT FOR TAXABLE YEARS BEGIN-
NING ON OR AFTER JANUARY FIRST, TWO THOUSAND SIXTEEN, AND (I)
FORTY-THREE PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND SEVENTEEN.
(2) IN NO EVENT SHALL THE CREDIT HEREIN PROVIDED FOR, AND CARRYOVERS
OF SUCH CREDIT, BE ALLOWED IN AN AMOUNT WHICH WILL REDUCE THE TAX PAYA-
BLE TO LESS THAN THE DOLLAR AMOUNT FIXED AS A MINIMUM TAX BY SUBSECTION
(B) OF SECTION FOURTEEN HUNDRED FIFTY-FIVE OF THIS ARTICLE. IF, HOWEVER,
THE AMOUNT OF CREDIT OR CARRYOVERS OF SUCH CREDIT, OR BOTH, ALLOWABLE
UNDER THIS SUBSECTION FOR ANY TAXABLE YEAR REDUCES THE TAX TO SUCH
AMOUNT, ANY AMOUNT OF CREDIT OR CARRYOVERS OF SUCH CREDIT THUS NOT
DEDUCTIBLE IN SUCH TAXABLE YEAR MAY BE CARRIED OVER TO THE FOLLOWING
YEAR OR YEARS AND MAY BE DEDUCTED FROM THE TAXPAYER'S TAX FOR SUCH YEAR
OR YEARS.
(3) FOR THE PURPOSES OF THIS SECTION THE TERM "QUALIFIED SMALL EMPLOY-
ER" SHALL MEAN AN INDIVIDUAL PROPRIETOR WHO IS THE SOLE EMPLOYEE OF THE
BUSINESS OR AN EMPLOYER WITH NOT MORE THAN FIFTY EMPLOYEES WHO IS A
"SMALL BUSINESS TAXPAYER" AS DEFINED IN PARAGRAPH (F) OF SUBDIVISION ONE
OF SECTION TWO HUNDRED TEN OF THIS CHAPTER.
S. 3092 9
(4) FOR THE PURPOSES OF THIS SUBSECTION, THE TERM "HEALTH INSURANCE"
MEANS AN ACCIDENT AND HEALTH INSURANCE POLICY SUBJECT TO THE PROVISIONS
OF SECTION THREE THOUSAND TWO HUNDRED SIXTEEN, THREE THOUSAND TWO
HUNDRED TWENTY-ONE, FOUR THOUSAND THREE HUNDRED THREE OR FOUR THOUSAND
EIGHT HUNDRED ONE OF THE INSURANCE LAW, AND ARTICLE FORTY-FOUR OF THE
PUBLIC HEALTH LAW AND SHALL INCLUDE "FREEDOM POLICIES" WHICH QUALIFY FOR
USE IN A HEALTH SAVINGS ACCOUNT PURSUANT TO SECTION 1201 OF THE FEDERAL
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT AND MODERNIZATION ACT OF 2003.
S 10. Section 1511 of the tax law is amended by adding a new subdivi-
sion (y) to read as follows:
(Y) SMALL EMPLOYER HEALTH CARE INSURANCE CREDIT. (1) A TAXPAYER SHALL
BE ALLOWED A CREDIT AGAINST THE TAX IMPOSED BY THIS ARTICLE EQUAL TO THE
APPLICABLE PERCENTAGE OF THE PREMIUMS PAID DURING THE TAXABLE YEAR FOR
HEALTH INSURANCE BY SUCH EMPLOYER. THE APPLICABLE PERCENTAGE SHALL BE
(A) FIVE PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST,
TWO THOUSAND NINE, (B) TEN PERCENT FOR TAXABLE YEARS BEGINNING ON OR
AFTER JANUARY FIRST, TWO THOUSAND TEN, (C) FIFTEEN PERCENT FOR TAXABLE
YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND ELEVEN, (D)
TWENTY PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST,
TWO THOUSAND TWELVE, (E) TWENTY-FIVE PERCENT FOR TAXABLE YEARS BEGINNING
ON OR AFTER JANUARY FIRST, TWO THOUSAND THIRTEEN, (F) THIRTY PERCENT FOR
TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND FOUR-
TEEN, (G) THIRTY-FIVE PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER
JANUARY FIRST, TWO THOUSAND FIFTEEN, (H) FORTY PERCENT FOR TAXABLE YEARS
BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND SIXTEEN, AND (I)
FORTY-THREE PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND SEVENTEEN.
(2) IN NO EVENT SHALL THE CREDIT HEREIN PROVIDED FOR BE ALLOWED IN AN
AMOUNT WHICH WILL REDUCE THE TAX PAYABLE TO LESS THAN THE MINIMUM FIXED
BY SUBDIVISION (A) OF SECTION FIFTEEN HUNDRED TWO OF THIS ARTICLE. IF,
HOWEVER, THE AMOUNT OF CREDIT ALLOWABLE UNDER THIS SUBDIVISION FOR ANY
TAXABLE YEAR REDUCES THE TAX TO SUCH AMOUNT, ANY AMOUNT OF CREDIT NOT
DEDUCTIBLE IN SUCH TAXABLE YEAR MAY BE CARRIED OVER TO THE FOLLOWING
YEAR OR YEARS AND MAY BE DEDUCTED FROM THE TAXPAYER'S TAX FOR SUCH YEAR
OR YEARS.
(3) FOR THE PURPOSES OF THIS SUBDIVISION THE TERM "QUALIFIED SMALL
EMPLOYER" SHALL MEAN AN INDIVIDUAL PROPRIETOR WHO IS THE SOLE EMPLOYEE
OF THE BUSINESS OR AN EMPLOYER WITH NOT MORE THAN FIFTY EMPLOYEES WHO IS
A "SMALL BUSINESS TAXPAYER" AS DEFINED IN PARAGRAPH (F) OF SUBDIVISION
ONE OF SECTION TWO HUNDRED TEN OF THIS CHAPTER.
(4) FOR THE PURPOSES OF THIS SUBDIVISION, THE TERM "HEALTH INSURANCE"
MEANS AN ACCIDENT AND HEALTH INSURANCE POLICY SUBJECT TO THE PROVISIONS
OF SECTION THREE THOUSAND TWO HUNDRED SIXTEEN, THREE THOUSAND TWO
HUNDRED TWENTY-ONE, FOUR THOUSAND THREE HUNDRED THREE OR FOUR THOUSAND
EIGHT HUNDRED ONE OF THE INSURANCE LAW, AND ARTICLE FORTY-FOUR OF THE
PUBLIC HEALTH LAW AND SHALL INCLUDE "FREEDOM POLICIES" WHICH QUALIFY FOR
USE IN A HEALTH SAVINGS ACCOUNT PURSUANT TO SECTION 1201 OF THE FEDERAL
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT AND MODERNIZATION ACT OF 2003.
S 11. Section 606 of the tax law is amended by adding a new subsection
(h-1) to read as follows:
(H-1) INDIVIDUAL ENROLLEE HEALTH INSURANCE CREDIT. A TAXPAYER SHALL BE
ALLOWED A CREDIT AGAINST THE TAX IMPOSED BY THIS ARTICLE EQUAL TO THE
APPLICABLE PERCENTAGE OF THE PREMIUM PAID DURING THE TAXABLE YEAR FOR
HEALTH INSURANCE PURCHASED PURSUANT TO SECTION FOUR THOUSAND THREE
HUNDRED TWENTY-ONE OR FOUR THOUSAND THREE HUNDRED TWENTY-TWO OF THE
INSURANCE LAW, INCLUDING "FREEDOM POLICIES" WHICH QUALIFY FOR USE IN A
S. 3092 10
HEALTH SAVINGS ACCOUNT PURSUANT TO SECTION 1201 OF THE FEDERAL MEDICARE
PRESCRIPTION DRUG, IMPROVEMENT AND MODERNIZATION ACT OF 2003. THE APPLI-
CABLE PERCENTAGE SHALL BE (1) FIVE PERCENT FOR TAXABLE YEARS BEGINNING
ON OR AFTER JANUARY FIRST, TWO THOUSAND NINE, (2) TEN PERCENT FOR TAXA-
BLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND TEN, (3)
FIFTEEN PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST,
TWO THOUSAND ELEVEN, (4) TWENTY PERCENT FOR TAXABLE YEARS BEGINNING ON
OR AFTER JANUARY FIRST, TWO THOUSAND TWELVE, (5) TWENTY-FIVE PERCENT FOR
TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND THIR-
TEEN, (6) THIRTY PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY
FIRST, TWO THOUSAND FOURTEEN, (7) THIRTY-FIVE PERCENT FOR TAXABLE YEARS
BEGINNING ON OR AFTER JANUARY FIRST, TWO THOUSAND FIFTEEN, (8) FORTY
PERCENT FOR TAXABLE YEARS BEGINNING ON OR AFTER JANUARY FIRST, TWO THOU-
SAND SIXTEEN, AND (9) FORTY-THREE PERCENT FOR TAXABLE YEARS BEGINNING ON
OR AFTER JANUARY FIRST, TWO THOUSAND SEVENTEEN.
S 12. Subsection (c) of section 4326 of the insurance law, as added by
chapter 1 of the laws of 1999, subparagraph (A) of paragraph 1 and
subparagraph (C) of paragraph 3 as amended by chapter 419 of the laws of
2000, is amended to read as follows:
(c) The following definitions shall be applicable to the insurance
contracts offered under the program established by this section:
(1) A qualifying small employer is an employer that is either:
(A) An individual proprietor who is the only employee of the business:
(i) without health insurance which provides benefits on an expense
reimbursed or prepaid basis in effect during the twelve month period
prior to application for a qualifying group health insurance contract
under the program established by this section; and
(ii) resides in a household having a net household income at or below
two hundred [eight] FIFTY percent of the non-farm federal poverty level
(as defined and updated by the federal department of health and human
services) or the gross equivalent of such net income;
(iii) except that the requirements set forth in item (i) of this
subparagraph shall not be applicable where an individual proprietor had
health insurance coverage during the previous twelve months and such
coverage terminated due to one of the reasons set forth in items (i)
through (viii) of subparagraph (C) of paragraph three of THIS subsection
[(c) of this section]; or
(B) An employer with:
(i) not more than fifty eligible employees;
(ii) no group health insurance which provides benefits on an expense
reimbursed or prepaid basis covering employees in effect during the
twelve month period prior to application for a qualifying group health
insurance contract under the program established by this section; and
(iii) at least thirty percent of its eligible employees receiving
annual wages from the employer at a level equal to or less than thirty
thousand dollars. The thirty thousand dollar figure shall be adjusted
periodically pursuant to subparagraph (F) of this paragraph.
(C) The requirements set forth in item (i) of subparagraph (A) of this
paragraph and in item (ii) of subparagraph (B) of this paragraph shall
not be applicable where an individual proprietor or employer is trans-
ferring from a health insurance contract issued pursuant to the New York
state small business health insurance partnership program established by
section nine hundred twenty-two of the public health law or from health
care coverage issued pursuant to a regional pilot project for the unin-
sured established by section one thousand one hundred eighteen of this
chapter.
S. 3092 11
(D) The twelve month period set forth in item (i) of subparagraph (A)
of this paragraph and in item (ii) of subparagraph (B) of this paragraph
may be adjusted by the superintendent from twelve months to eighteen
months if he determines that the twelve month period is insufficient to
prevent inappropriate substitution of other health insurance contracts
for qualifying group health insurance contracts.
(E) An individual proprietor or employer shall cease to be a qualify-
ing small employer if any health insurance which provides benefits on an
expense reimbursed or prepaid basis covering the individual proprietor
or an employer's employees, other than qualifying group health insurance
purchased pursuant to this section, is purchased or otherwise takes
effect subsequent to purchase of qualifying group health insurance under
the program established by this section.
(F) The wage levels utilized in subparagraph (B) of this paragraph
shall be adjusted annually, beginning in two thousand two. The adjust-
ment shall take effect on July first of each year. For July first, two
thousand two, the adjustment shall be a percentage of the annual wage
figure specified in subparagraph (B) of this paragraph. For subsequent
years, the adjustment shall be a percentage of the annual wage figure
which took effect on July first of the prior year. The percentage
adjustment shall be the same percentage by which the current year's
non-farm federal poverty level, as defined and updated by the federal
department of health and human services, for a family unit of four
persons for the forty-eight contiguous states and Washington, D.C.,
changed from the same level established for the prior year.
(2) A qualifying group health insurance contract is a group contract
purchased from a health maintenance organization, corporation or insurer
by a qualifying small employer which provides the benefits set forth in
subsection (d) of this section. The contract must insure not less than
fifty percent of the employees eligible for coverage.
(3) (A) A qualifying individual is an employed person:
(i) who does not have and has not had health insurance with benefits
on an expense reimbursed or prepaid basis during the twelve month period
prior to the individual's application for health insurance under the
program established by this section;
(ii) whose employer does not provide group health insurance and has
not provided group health insurance with benefits on an expense reim-
bursed or prepaid basis covering employees in effect during the twelve
month period prior to the individual's application for health insurance
under the program established by this section;
(iii) [resides] RESIDING in a household having a net household income
at or below two hundred [eight] FIFTY percent of the non-farm federal
poverty level (as defined and updated by the federal department of
health and human services) or the gross equivalent of such net income[;]
and
[(iv)] WHO is ineligible for Medicare.
(B) The requirements set forth in items (i) and (ii) of subparagraph
(A) of this paragraph shall not be applicable where an individual is
transferring from a health insurance contract issued pursuant to the
voucher insurance program established by section one thousand one
hundred twenty-one of this chapter, a health insurance contract issued
pursuant to the New York state small business health insurance partner-
ship program established by section nine hundred twenty-two of the
public health law or health care coverage issued pursuant to a regional
pilot project for the uninsured established by section one thousand one
hundred eighteen of this chapter.
S. 3092 12
(C) The requirements set forth in items (i) and (ii) of subparagraph
(A) of this paragraph shall not be applicable where an individual had
health insurance coverage during the previous twelve months and such
coverage terminated due to:
(i) loss of employment due to factors other than voluntary separation;
(ii) death of a family member which results in termination of coverage
under a health insurance contract under which the individual is covered;
(iii) change to a new employer that does not provide group health
insurance with benefits on an expense reimbursed or prepaid basis;
(iv) change of residence so that no employer-based health insurance
with benefits on an expense reimbursed or prepaid basis is available;
(v) discontinuation of a group health insurance contract with benefits
on an expense reimbursed or prepaid basis covering the qualifying indi-
vidual as an employee or dependent;
(vi) expiration of the coverage periods established by the continua-
tion provisions of the Employee Retirement Income Security Act, 29
U.S.C. section 1161 et seq. and the Public Health Service Act, 42
U.S.C. section 300bb-1 et seq. established by the Consolidated Omnibus
Budget Reconciliation Act of 1985, as amended, or the continuation
provisions of subsection (m) of section three thousand two hundred twen-
ty-one, subsection (k) of section four thousand three hundred four and
subsection (e) of section four thousand three hundred five of this chap-
ter;
(vii) legal separation, divorce or annulment which results in termi-
nation of coverage under a health insurance contract under which the
individual is covered; or
(viii) loss of eligibility under a group health plan.
(D) The twelve month period set forth in items (i) and (ii) of subpar-
agraph (A) of this paragraph may be adjusted by the superintendent from
twelve months to eighteen months if he determines that the twelve month
period is insufficient to prevent inappropriate substitution of other
health insurance contracts for qualifying individual health insurance
contracts.
(4) A qualifying individual health insurance contract is an individual
contract issued directly to a qualifying individual and which provides
the benefits set forth in subsection (d) of this section. At the option
of the qualifying individual, such contract may include coverage for
dependents of the qualifying individual.
(5) A QUALIFYING INDIVIDUAL RESIDING IN A HOUSEHOLD HAVING A NET
INCOME ABOVE TWO HUNDRED FIFTY PERCENT OF THE NON-FARM POVERTY LEVEL (AS
DEFINED AND UPDATED BY THE FEDERAL DEPARTMENT OF HEALTH AND HUMAN
SERVICES) OR THE GROSS EQUIVALENT OF SUCH NET INCOME SHALL BE ELIGIBLE
TO PURCHASE A QUALIFYING INDIVIDUAL HEALTH INSURANCE CONTRACT.
PROVIDED, HOWEVER, PREMIUMS SHALL BE PAID TO THE INSURER OR HEALTH MAIN-
TENANCE ORGANIZATION AT A RATE WHICH DOES NOT INCLUDE ACTUARIAL
REDUCTIONS DERIVED FROM THE MARKET STABILIZATION POOLS CREATED PURSUANT
TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-THREE OF THIS CHAPTER.
S 13. Paragraphs 4 and 6 of subsection (e) of section 4326 of the
insurance law, as added by chapter 1 of the laws of 1999, are amended to
read as follows:
(4) emergency services shall have a [fifty] ONE HUNDRED dollar copay-
ment which must be waived if hospital admission results from the emer-
gency room visit;
(6) the maximum coverage for prescription drugs shall be [three] FIVE
thousand dollars per individual in a calendar year; and
S. 3092 13
S 14. Subsection (g) of section 4326 of the insurance law, as added by
chapter 1 of the laws of 1999, is amended to read as follows:
(g) The superintendent shall be authorized to modify, by regulation,
the copayment and deductible amounts described in this section if the
superintendent determines such amendments are necessary to [facilitate
implementation of this section] MAINTAIN THE PROGRAM. On or after Janu-
ary first, two thousand two, the superintendent shall be authorized to
establish, by regulation, one or more additional standardized health
insurance benefit packages if the superintendent determines additional
benefit packages with different levels of benefits are necessary to meet
the needs of the public.
S 15. Subsections (b) and (e) of section 4327 of the insurance law, as
added by chapter 1 of the laws of 1999, are amended to read as follows:
(b) Commencing on January first, two thousand one, health maintenance
organizations, corporations or insurers shall be eligible to receive
reimbursement for ninety percent of claims paid between thirty thousand
and one hundred thousand dollars AND COMMENCING JANUARY FIRST, TWO THOU-
SAND TEN, HEALTH MAINTENANCE ORGANIZATIONS, CORPORATIONS OR INSURERS
SHALL BE ELIGIBLE FOR REIMBURSEMENT FOR NINETY PERCENT OF CLAIMS IN
EXCESS OF FIVE HUNDRED THOUSAND DOLLARS in a calendar year for any
member covered under a standardized contract issued pursuant to section
four thousand three hundred twenty-six of this article. Claims paid for
members covered under qualifying group health insurance contracts shall
be reimbursable from the small employer stop loss fund. Claims paid for
members covered under qualifying individual health insurance contracts
shall be reimbursable from the qualifying individual stop loss fund. For
the purposes of this section, claims shall include health care claims
paid by a health maintenance organization on behalf of a covered member
pursuant to such standardized contracts.
(e) Claims shall be reported and funds shall be distributed from the
small employer stop loss fund and from the qualifying individual stop
loss fund on a calendar year basis. Claims shall be eligible for
reimbursement only for the calendar year in which the claims are paid.
[Once claims paid on behalf of a covered member reach or exceed one
hundred thousand dollars in a given calendar year, no further claims
paid on behalf of such member in that calendar year shall be eligible
for reimbursement.]
S 16. Subsections (a) and (c) of section 4321-a of the insurance law,
as added by chapter 1 of the laws of 1999, are amended to read as
follows:
(a) The superintendent shall establish a fund from which health main-
tenance organizations may receive reimbursement, to the extent of funds
available therefor, for claims paid by such health maintenance organiza-
tions for members covered under standardized individual enrollee direct
payment contracts issued pursuant to section four thousand three hundred
twenty-one of this article. The fund established by the superintendent
pursuant to this section shall be known as the direct payment stop loss
fund. Commencing in calendar year two thousand, health maintenance
organizations shall be eligible to receive reimbursement from the direct
payment stop loss fund for ninety percent of claims paid between twenty
thousand and one hundred thousand dollars, AS WELL AS CLAIMS IN EXCESS
OF FIVE HUNDRED THOUSAND DOLLARS, in a calendar year for any member
covered under a contract issued pursuant to section four thousand three
hundred twenty-one of this article. For the purposes of this section,
claims shall include health care claims paid by a health maintenance
S. 3092 14
organization on behalf of a covered member pursuant to such standardized
direct payment contracts.
(c) Claims shall be reported and funds shall be distributed on a
calendar year basis. Claims shall be eligible for reimbursement only for
the calendar year in which the claims are paid. Once claims paid on
behalf of a member reach or exceed one hundred thousand dollars in a
given calendar year, no further claims paid on behalf of such member in
such calendar year shall be eligible for reimbursement UNTIL THE CLAIMS
REACH FIVE HUNDRED THOUSAND DOLLARS.
S 17. Subsections (a) and (c) of section 4322-a of the insurance law,
as added by chapter 1 of the laws of 1999, are amended to read as
follows:
(a) The superintendent shall establish a fund from which health main-
tenance organizations may receive reimbursement, to the extent of funds
available therefor, for claims paid by such health maintenance organiza-
tions for members covered under standardized individual enrollee direct
payment contracts which provide out-of-plan benefits issued pursuant to
section four thousand three hundred twenty-two of this article. The fund
established by the superintendent pursuant to this section shall be
known as "the direct payment out-of-plan stop loss fund". Commencing in
calendar year two thousand, health maintenance organizations shall be
eligible to receive reimbursement from the direct payment out-of-plan
stop loss fund for ninety percent of claims paid between twenty thousand
and one hundred thousand dollars, AS WELL AS CLAIMS IN EXCESS OF FIVE
HUNDRED THOUSAND DOLLARS, in a calendar year for any member covered
under a contract issued pursuant to section four thousand three hundred
twenty-two of this article. For the purposes of this section, claims
shall include health care claims paid by a health maintenance organiza-
tion on behalf of a covered member pursuant to contracts issued pursuant
to section four thousand three hundred twenty-two of this article.
(c) Claims shall be reported and funds shall be distributed on a
calendar year basis. Claims shall be eligible for reimbursement only for
the calendar year in which the claims are paid. Once claims paid on
behalf of a member reach or exceed one hundred thousand dollars in a
given calendar year, no further claims paid on behalf of such member in
that calendar year shall be eligible for reimbursement UNTIL THE CLAIMS
REACH FIVE HUNDRED THOUSAND DOLLARS.
S 18. Subsection (b) of section 3231 of the insurance law, as amended
by chapter 557 of the laws of 2002, is amended to read as follows:
(b) Nothing herein shall prohibit the use of premium rate structures
to establish different premium rates for individuals as opposed to fami-
ly units or separate community rates for individuals as opposed to small
groups. NOTHING HEREIN SHALL REQUIRE THAT ALL PRODUCTS IN THE SAME
COMMUNITY POOL HAVE AN IDENTICAL CHANGE IN PREMIUM; AN INSURER MAY
SUBSEQUENTLY INCREASE OR DECREASE THE PREMIUM OF ONE PRODUCT BY A
DIFFERENT PERCENTAGE THAN ANOTHER PRODUCT BASED ON DIFFERING UTILIZATION
OR OTHER FACTORS (AS DETERMINED BY THE INSURER), EVEN THOUGH BOTH
PRODUCTS ARE IN THE SAME COMMUNITY POOL. If an insurer is required to
issue a contract to individual proprietors pursuant to subsection (i) of
this section, such policy shall be subject to subsection (a) of this
section.
S 19. Subsection (b) of section 4317 of the insurance law, as amended
by chapter 557 of the laws of 2002, is amended to read as follows:
(b) Nothing herein shall prohibit the use of premium rate structures
to establish different premium rates for individuals as opposed to fami-
ly units or separate community rates for individuals as opposed to small
S. 3092 15
groups. NOTHING HEREIN SHALL REQUIRE THAT ALL PRODUCTS IN THE SAME
COMMUNITY POOL HAVE AN IDENTICAL CHANGE IN PREMIUM; AN INSURER MAY
SUBSEQUENTLY INCREASE OR DECREASE THE PREMIUM OF ONE PRODUCT BY A
DIFFERENT PERCENTAGE THAN ANOTHER PRODUCT BASED ON DIFFERING UTILIZATION
OR OTHER FACTORS (AS DETERMINED BY THE INSURER), EVEN THOUGH BOTH
PRODUCTS ARE IN THE SAME COMMUNITY POOL. If a corporation is required to
issue a contract to individual proprietors pursuant to subsection (f) of
this section, such contract shall be subject to the requirements of
subsection (a) of this section.
S 20. Subdivision 3 of section 4401 of the public health law, as added
by chapter 938 of the laws of 1976, is amended to read as follows:
3. "Comprehensive health services" means all those health services
which an enrolled population might require in order to be maintained in
good health, and shall include, but shall not be limited to, physician
services (including consultant and referral services), in-patient and
out-patient hospital services, diagnostic laboratory and therapeutic and
diagnostic radiologic services, and emergency and preventive health
services. Such term may be further defined by agreement with enrolled
populations providing additional benefits necessary, desirable or appro-
priate to meet their health care needs. NOTWITHSTANDING THE PRECEDING,
IN THE CASE OF GROUPS WITH FIFTY-ONE OR MORE EMPLOYEES, SUBSCRIBERS OR
MEMBERS, EXCLUSIVE OF SPOUSES AND DEPENDENTS, A HEALTH MAINTENANCE
ORGANIZATION MAY OFFER CONTRACTS WITH THOSE DEDUCTIBLES, COINSURANCE,
COPAYMENTS AND OTHER LIMITATIONS ON BENEFITS NECESSARY TO MATCH THE
BENEFITS OF THE OTHER HEALTH BENEFIT OFFERINGS OF SUCH GROUPS AND THERE-
BY ATTEMPT TO AVOID ADVERSE SELECTION.
S 21. Subdivision 1 of section 4406 of the public health law, as
amended by chapter 342 of the laws of 2004, is amended to read as
follows:
1. The contract between a health maintenance organization and an
enrollee shall be subject to regulation by the superintendent as if it
were a health insurance subscriber contract, and shall include, but not
be limited to, all mandated benefits required by article forty-three of
the insurance law. Such contract shall fully and clearly state the bene-
fits and limitations therein provided or imposed, so as to facilitate
understanding and comparisons, and to exclude provisions which may be
misleading or unreasonably confusing. Such contract shall be issued to
any individual and dependents of such individual and any group of fifty
or fewer employees or members, exclusive of spouses and dependents, or
any employee or member of the group, including dependents, applying for
such contract at any time throughout the year, and may include a pre-ex-
isting condition provision as provided for in section four thousand
three hundred eighteen of the insurance law, provided, however, that
such requirements shall not apply to a health maintenance organization
exclusively serving individuals enrolled pursuant to title eleven of
article five of the social services law, title eleven-D of article five
of the social services law, title one-A of article twenty-five of the
public health law or title eighteen of the federal Social Security Act,
and, further provided, that such health maintenance organization shall
not discontinue a contract for an individual receiving comprehensive-
type coverage in effect prior to January first, two thousand four who is
ineligible to purchase policies offered after such date pursuant to this
section or section four thousand three hundred twenty-two of [this arti-
cle] THE INSURANCE LAW due to the provision of 42 U.S.C. 1395ss in
effect prior to January first, two thousand four; AND PROVIDED FURTHER,
HOWEVER, THAT IN THE CASE OF LARGE GROUPS NOT SUBJECT TO SECTION FOUR
S. 3092 16
THOUSAND THREE HUNDRED SEVENTEEN OF THE INSURANCE LAW THE HEALTH MAINTE-
NANCE ORGANIZATION MAY APPLY THE SAME MINIMUM PARTICIPATION AND OTHER
ENROLLMENT STANDARDS AS AN INSURER IS PERMITTED TO APPLY PURSUANT TO THE
INSURANCE LAW. Subject to the creditable coverage requirements of
subsection (a) of section four thousand three hundred eighteen of the
insurance law, the organization may, as an alternative to the use of a
pre-existing condition provision, elect to offer contracts without a
pre-existing condition provision to such groups but may require that
coverage shall not become effective until after a specified affiliation
period of not more than sixty days after the application for coverage is
submitted. The organization is not required to provide health care
services or benefits during such period and no premium shall be charged
for any coverage during the period. After January first, nineteen
hundred ninety-six, all individual direct payment contracts shall be
issued only pursuant to sections four thousand three hundred twenty-one
and four thousand three hundred twenty-two of the insurance law. Such
contracts may not, with respect to an eligible individual (as defined in
section 2741(b) of the federal Public Health Service Act, 42 U.S.C. S
300gg-41(b)), impose any pre-existing condition exclusion.
S 22. Section 4406 of the public health law is amended by adding a new
subdivision 5 to read as follows:
5. NOTWITHSTANDING ANY OTHER LAW, REGULATION OR DEPARTMENTAL POLICY,
IN THE CASE OF OFFERINGS TO GROUPS WITH FIFTY-ONE OR MORE EMPLOYEES,
SUBSCRIBERS OR MEMBERS, EXCLUSIVE OF SPOUSES AND DEPENDENTS, A HEALTH
MAINTENANCE ORGANIZATION MAY ELECT NOT TO OFFER COVERAGE TO THE GROUP AS
A WHOLE IF THE BENEFIT PACKAGES OF THE OTHER PLANS OFFERED BY THE GROUP,
OR THE AMOUNTS CONTRIBUTED BY THE GROUP TOWARDS THE PREMIUMS, ARE LIKELY
TO PROMOTE ADVERSE SELECTION.
S 23. Section 2406 of the insurance law is amended by adding a new
subsection (f) to read as follows:
(F) ALL FINES AND PENALTIES PAID AND COLLECTED PURSUANT TO THIS
SECTION SHALL BE DEPOSITED IN AND DISTRIBUTED THROUGH POOLS CREATED
PURSUANT TO SECTION THREE THOUSAND TWO HUNDRED THIRTY-THREE OF THIS
CHAPTER ESTABLISHED AND OPERATED FOR THE PURPOSE OF MARKET STABILIZATION
MECHANISMS FOR INDIVIDUAL, SMALL GROUP AND MEDICARE SUPPLEMENTAL INSUR-
ANCE.
S 24. This act shall take effect January 1, 2010; provided, however
that the empire state film production credit under subsection (gg) , the
empire state commercial production credit under subsection (jj) and the
credit for companies who provide transportation to individuals with
disabilities under subsection (oo) of section 606 of the tax law
contained in section seven of this act shall expire on the same date as
provided in section 9 of part P of chapter 60 of the laws of 2004, as
amended, section 10 of part V of chapter 62 of the laws of 2006, as
amended and section 5 of chapter 522 of the laws of 2006, as amended,
respectively.
Comments
Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.
Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.
Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.