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

                                  8300

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                              June 18, 2015
                               ___________

Introduced  by  M.  of  A.  SEAWRIGHT  --  read once and referred to the
  Committee on Ways and Means

AN ACT to amend the insurance law, in relation to catastrophic or  rein-
  surance  coverage issued to certain small groups; and to amend a chap-
  ter of the laws  of  2015  amending  the  insurance  law  relating  to
  catastrophic  or  reinsurance coverage issued to certain small groups,
  as proposed in legislative bills numbers S. 5928-A and A.  8134-A,  in
  relation  to  the  effectiveness  of  such chapter; and in relation to
  directing the superintendent of financial services to contract with an
  independent entity to conduct an assessment regarding  the  impact  of
  the prohibition on the sale of stop loss, catastrophic and reinsurance
  coverage to the small group market

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

  Section 1. Paragraph 1 of subsection (h) of section 3231 of the insur-
ance law, as amended by a chapter of  the  laws  of  2015  amending  the
insurance law relating to catastrophic or reinsurance coverage issued to
certain small groups, as proposed in legislative bills numbers S. 5928-A
and A. 8134-A, is amended to read as follows:
  (1)  Notwithstanding  any other provision of this chapter, no insurer,
subsidiary of an insurer, or controlled  person  of  a  holding  company
system may act as an administrator or claims paying agent, as opposed to
an  insurer,  on  behalf of small groups which, if they purchased insur-
ance, would be subject to this section. No  insurer,  subsidiary  of  an
insurer,  or  controlled  person  of  a holding company may provide stop
loss, catastrophic or reinsurance coverage to  small  groups  which,  if
they  purchased  insurance, would be subject to this section.  Provided,
however, the provisions of this paragraph shall not apply to stop  loss,
catastrophic  or  reinsurance coverage issued and in effect on or before
[June] JANUARY first, two thousand  fifteen  to  small  groups  covering
between fifty-one and one hundred employees or members of the group.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11569-13-5
              

A. 8300                             2

  S  2.  Paragraph  1 of subsection (e) of section 4317 of the insurance
law, as amended by a chapter of the laws of 2015 amending the  insurance
law  relating  to catastrophic or reinsurance coverage issued to certain
small groups, as proposed in legislative bills numbers S. 5928-A and  A.
8134-A, is amended to read as follows:
  (1)  Notwithstanding  any other provision of this chapter, no insurer,
subsidiary of an insurer, or controlled  person  of  a  holding  company
system may act as an administrator or claims paying agent, as opposed to
an  insurer,  on  behalf of small groups which, if they purchased insur-
ance, would be subject to this section. No  insurer,  subsidiary  of  an
insurer,  or  controlled  person  of  a holding company may provide stop
loss, catastrophic or reinsurance coverage to  small  groups  which,  if
they  purchased  insurance,  would be subject to this section. Provided,
however, the provisions of this paragraph shall not apply to stop  loss,
catastrophic  or  reinsurance coverage issued and in effect on or before
[June] JANUARY first, two thousand  fifteen  to  small  groups  covering
between fifty-one and one hundred employees or members of the group.
  S 3. Section 5 of a chapter of the laws of 2015 amending the insurance
law  relating  to catastrophic or reinsurance coverage issued to certain
small groups, as proposed in  legislative  bills  numbers  S.5928-A  and
A.8134-A, is amended to read as follows:
  S  5.  This  act  shall  take  effect immediately; and shall be deemed
repealed [5] 2 years after it shall have become a law.
  S 4. 1. The superintendent of financial services shall  contract  with
an  independent  entity to conduct an assessment regarding the impact of
the prohibition on the sale of stop loss, catastrophic  and  reinsurance
coverage  to the small group market. Such contract shall be awarded on a
competitive basis through a request for proposals process. Issues to  be
assessed shall include, but not be limited to, the following:
  (a) the costs to small group employers of providing health coverage;
  (b) the ability of small group employers to continue to provide health
coverage;
  (c)  benefit  package and wellness program comparability between self-
insured and small group products;
  (d) whether the inability of  small  group  employers  to  self-insure
affects  such  employers'  ability  to remain in or relocate to New York
state;
  (e) the impact of allowing the sale  of  stop  loss,  catastrophic  or
reinsurance coverage to groups with 51-100 employees or members exempted
from  paragraph  1  of subsection (h) of section 3231 and paragraph 1 of
subsection (e) of section 4317 of the insurance law by a chapter of  the
laws  of  2015  amending  the  insurance law relating to catastrophic or
reinsurance coverage issued to certain  small  groups,  as  proposed  in
legislative bills numbers S.5928-A and A.8134-A, on the affordability of
health  insurance  purchased in the small group health insurance market,
including:
  (i) the impact on the premiums within the small group health insurance
market of allowing such exempted groups to obtain stop loss, catastroph-
ic or reinsurance coverage; and
  (ii) whether allowing the sale of stop loss, catastrophic or  reinsur-
ance  coverage  to  such  exempted groups with 51-100 members results in
adverse selection within the small  group  health  insurance  market  by
allowing  such groups to select either stop loss or a small group insur-
ance product; and
  (f) differences in consumer protections  provided  under  small  group
health  insurance  products  versus  those  provided  under  stop  loss,

A. 8300                             3

catastrophic or reinsurance coverage  including,  but  not  limited  to,
differences  in limits on cost sharing, network adequacy, patient appeal
rights, consumer review of rates  during  the  prior  approval  process,
department  of  financial  services  audits  and  oversight  and insurer
solvency requirements.
  2. The department of financial services shall submit its report to the
governor, the temporary president of the  senate,  the  speaker  of  the
assembly,  and the chairs of the senate and assembly standing committees
on insurance no later than January 1, 2017.
  S 5. This act shall take effect on the  same  date  and  in  the  same
manner  as  a  chapter  of  the  laws of 2015 amending the insurance law
relating to catastrophic or reinsurance coverage issued to certain small
groups, as proposed in legislative bills numbers S.5928-A and  A.8134-A,
takes effect.