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

                                  8228

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                              June 7, 2011
                               ___________

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

AN ACT to amend the insurance law and the public health law, in relation
  to making  actuarially  appropriate  reductions  in  health  insurance
  premiums  in  return for an enrollee's or insured's participation in a
  qualified wellness program

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

  Section  1. Section 3231 of the insurance law, as added by chapter 501
of the laws of 1992, is amended by adding a new subsection (c-1) to read
as follows:
  (C-1) SUBJECT TO THE APPROVAL OF THE  SUPERINTENDENT,  AN  INSURER  OR
HEALTH  MAINTENANCE  ORGANIZATION  ISSUING AN INDIVIDUAL OR GROUP HEALTH
INSURANCE POLICY PURSUANT TO THIS SECTION MAY PROVIDE FOR AN ACTUARIALLY
APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS
APPROVED BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S  OR  INSURED'S
ACTIVE  PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELL-
NESS PROGRAM CAN BE A RISK MANAGEMENT  SYSTEM  THAT  IDENTIFIES  AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH  HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BE-
ING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS  OF  ACUTE  OR  CHRONIC
SICKNESS,  DISEASE  OR  PAIN,  OR  WHICH MINIMIZES ADVERSE HEALTH CONSE-
QUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR  ALL
OF  THE  FOLLOWING  ELEMENTS  TO  ADVANCE THE PHYSICAL HEALTH AND MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1) AN EDUCATION PROGRAM TO INCREASE  THE  AWARENESS  OF  AND  DISSEM-
INATION  OF  INFORMATION  ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH
WARNS ABOUT RISKS OF PURSUING  ENVIRONMENTAL  OR  BEHAVIORAL  ACTIVITIES
THAT  ARE  DETRIMENTAL  TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE
AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY  IDENTIFI-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10001-01-1

              

A. 8228                             2

CATION  AND  TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 2. Subsection (h) of section 4235 of the insurance law is amended by
adding a new paragraph 5 to read as follows:
  (5) EACH INSURER DOING BUSINESS IN THIS STATE, WHEN  FILING  WITH  THE
SUPERINTENDENT  ITS SCHEDULES OF PREMIUM RATES, RULES AND CLASSIFICATION
OF RISKS FOR USE IN CONNECTION WITH THE  ISSUANCE  OF  ITS  POLICIES  OF
GROUP ACCIDENT, GROUP HEALTH OR GROUP ACCIDENT AND HEALTH INSURANCE, MAY
PROVIDE  FOR  AN  ACTUARIALLY  APPROPRIATE REDUCTION IN PREMIUM RATES OR
OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOUR-
AGE AN ENROLLEE'S OR INSURED'S ACTIVE PARTICIPATION IN A QUALIFIED WELL-
NESS PROGRAM. A QUALIFIED WELLNESS PROGRAM  CAN  BE  A  RISK  MANAGEMENT
SYSTEM  THAT  IDENTIFIES  AT-RISK  POPULATIONS  OR  ANY OTHER SYSTEMATIC
PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND
MENTAL FITNESS, HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE  THE
CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINI-
MIZES  ADVERSE  HEALTH  CONSEQUENCES DUE TO LIFESTYLE.   SUCH A WELLNESS
PROGRAM MAY HAVE SOME OR ALL OF THE FOLLOWING ELEMENTS  TO  ADVANCE  THE
PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (A)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETIES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (B) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES.  SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (I) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (II) PROMOTION OF HEALTHY EATING HABITS,
  (III) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (IV) INSTITUTING A PROPER FITNESS REGIMEN,
  (V) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (VI) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND

A. 8228                             3

  (C) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 3. Section 4317 of the insurance law is  amended  by  adding  a  new
subsection (c-1) to read as follows:
  (C-1)  SUBJECT  TO  THE  APPROVAL OF THE SUPERINTENDENT, AN INSURER OR
HEALTH MAINTENANCE ORGANIZATION ISSUING AN INDIVIDUAL  OR  GROUP  HEALTH
INSURANCE  CONTRACT PURSUANT TO THIS SECTION MAY PROVIDE FOR AN ACTUARI-
ALLY APPROPRIATE  REDUCTION  IN  PREMIUM  RATES  OR  OTHER  BENEFITS  OR
ENHANCEMENTS  APPROVED  BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S
OR INSURED'S ACTIVE PARTICIPATION IN A  QUALIFIED  WELLNESS  PROGRAM.  A
QUALIFIED  WELLNESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT IDENTI-
FIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM  OR  COURSE  OF
MEDICAL  CONDUCT  WHICH  HELPS  TO  PROMOTE PHYSICAL AND MENTAL FITNESS,
HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE  THE  CONDITIONS  OF
ACUTE  OR  CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINIMIZES ADVERSE
HEALTH CONSEQUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY  HAVE
SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND
MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 4. Subsection (n) of section 4326 of the insurance law is amended by
adding a new paragraph 4 to read as follows:
  (4) APPROVAL OF THE SUPERINTENDENT, AN INSURER OR  HEALTH  MAINTENANCE
ORGANIZATION  ISSUING A CONTRACT FOR QUALIFYING SMALL EMPLOYERS OR INDI-
VIDUALS PURSUANT TO THIS SECTION MAY PROVIDE FOR AN  ACTUARIALLY  APPRO-

A. 8228                             4

PRIATE  REDUCTION  IN  PREMIUM  RATES  OR OTHER BENEFITS OR ENHANCEMENTS
APPROVED BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S  OR  INSURED'S
ACTIVE  PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELL-
NESS  PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 5. Section 4405 of the public health law is amended by adding a  new
subdivision 5-a to read as follows:
  5-A. SUBJECT TO THE APPROVAL OF THE SUPERINTENDENT, MAY PROVIDE FOR AN
ACTUARIALLY  APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR
ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOURAGE  AN  ENROLLEE'S
ACTIVE  PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELL-
NESS PROGRAM CAN BE A RISK MANAGEMENT  SYSTEM  THAT  IDENTIFIES  AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH  HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BE-
ING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS  OF  ACUTE  OR  CHRONIC
SICKNESS,  DISEASE  OR  PAIN,  OR  WHICH MINIMIZES ADVERSE HEALTH CONSE-
QUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR  ALL
OF  THE  FOLLOWING  ELEMENTS  TO  ADVANCE THE PHYSICAL HEALTH AND MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1) AN EDUCATION PROGRAM TO INCREASE  THE  AWARENESS  OF  AND  DISSEM-
INATION  OF  INFORMATION  ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH
WARNS ABOUT RISKS OF PURSUING  ENVIRONMENTAL  OR  BEHAVIORAL  ACTIVITIES
THAT  ARE  DETRIMENTAL  TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE
AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY  IDENTIFI-

A. 8228                             5

CATION  AND  TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A
RESULT OF AN ENROLLEE'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM;
  S 6. This act shall take effect on the one hundred eightieth day after
it shall have become a law; provided  that,  effective  immediately  any
rules  and regulations necessary to implement the provisions of this act
on its effective date are authorized and directed to be  added,  amended
and/or repealed on or before such date.