NY State Senate Bill 2015-S6004

Senate Bill S6004

Signed By Governor

2015-2016 Legislative Session

Relates to catastrophic or reinsurance coverage issued to certain small groups

download bill text pdf

Archive: Last Bill Status - Signed by Governor

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

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Actions

View Actions

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Dec 28, 2015	approval memo.43 signed chap.589
Dec 16, 2015	delivered to governor
Jun 25, 2015	returned to senate passed assembly ordered to third reading rules cal.747 substituted for a8300 referred to ways and means delivered to assembly passed senate ordered to third reading cal.1908
Jun 19, 2015	referred to rules

Votes

- Jun 25, 2015 - Floor Vote
  S6004
  
  59
  
  Aye
  
  0
  
  Nay
  
  1
  
  Absent
  
  3
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: Jun 25, 2015
      
      aye (59)
      
      Addabbo Jr.
      
      Amedore
      
      Avella
      
      Bonacic
      
      Boyle
      
      Breslin
      
      Carlucci
      
      Comrie
      
      Croci
      
      DeFrancisco
      
      Diaz
      
      Dilan
      
      Espaillat
      
      Farley
      
      Felder
      
      Flanagan
      
      Funke
      
      Gallivan
      
      Gianaris
      
      Golden
      
      Griffo
      
      Hamilton
      
      Hannon
      
      Hassell-Thompson
      
      Hoylman-Sigal
      
      Kennedy
      
      Klein
      
      Krueger
      
      LaValle
      
      Lanza
      
      Larkin
      
      Latimer
      
      Little
      
      Marcellino
      
      Marchione
      
      Martins
      
      Montgomery
      
      Murphy
      
      Nozzolio
      
      O'Mara
      
      Ortt
      
      Panepinto
      
      Parker
      
      Ranzenhofer
      
      Ritchie
      
      Rivera
      
      Robach
      
      Sanders Jr.
      
      Savino
      
      Serino
      
      Serrano
      
      Seward
      
      Skelos
      
      Squadron
      
      Stavisky
      
      Stewart-Cousins
      
      Valesky
      
      Venditto
      
      Young
      
      absent (1)
      
      Sampson
      
      excused (3)
      
      Libous
      
      Peralta
      
      Perkins
  Jun 25, 2015 - Rules Committee Vote
  S6004
  
  21
  
  Aye
  
  0
  
  Nay
  
  2
  
  Aye with Reservations
  
  1
  
  Absent
  
  1
  
  Excused
  
  0
  
  Abstained
  - - Rules Committee Vote: Jun 25, 2015
      
      aye (21)
      
      Bonacic
      
      Breslin
      
      Carlucci
      
      DeFrancisco
      
      Dilan
      
      Espaillat
      
      Farley
      
      Flanagan
      
      Hannon
      
      Hassell-Thompson
      
      LaValle
      
      Larkin
      
      Little
      
      Marcellino
      
      Montgomery
      
      Nozzolio
      
      Seward
      
      Skelos
      
      Stewart-Cousins
      
      Valesky
      
      Young
      
      aye wr (2)
      
      Gianaris
      
      Krueger
      
      absent (1)
      
      Parker
      
      excused (1)
      
      Perkins

2015-S6004 (ACTIVE) - Details

See Assembly Version of this Bill:: A8300
Law Section:: Insurance Law
Laws Affected:: Amd §§3231 & 4317, Ins L; amd §5, Chap of 2015 (as proposed in S.5928-A and A.8134-A)

2015-S6004 (ACTIVE) - Summary

Relates to catastrophic or reinsurance coverage issued to certain small groups.

2015-S6004 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S6004

TITLE OF BILL:  An act to amend the insurance law, in relation to
catastrophic or reinsurance coverage issued to certain small groups;
and to amend 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, 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

PURPOSE: The purpose of this bill is to amend a chapter of the laws of
2015 related to the sale of stop-loss, catastrophic and reinsurance
coverage to certain employers within the small-group health insurance
market.

SUMMARY OF PROVISIONS: This bill would provide that stop-loss,
catastrophic and reinsurance coverage may only be sold in the small
group health market to groups which already had such coverage as of
January 1st, 2015. The bill would sunset the exemption for these
groups in two years. Additionally, the bill would require the
Department of Financial Services to contract with an independent
entity to study the effects of the sale of stop-loss, catastrophic and
reinsurance coverage on the small group market.

JUSTIFICATION: The ACA expanded the "small group" market from 2-50 to
2-100 employees or members effective January 1st, 2016 in order to
place downward pressure on premiums through the law of large numbers
by including larger firms within the group. Expanding the small group
up to 100 members or employees required the sale of community-rated
policies-and prohibited the sale of stop loss, reinsurance or
catastrophic coverages-to groups with between 51-100 members or
employees for the first time. This included both private sector firms
and members of municipal cooperatives and schools which are members of
municipal cooperative associations pursuant to article five-G of the
general municipal law.

A8134A (Seawright)/S5928-A (Seward) of 2015 grandfathered 51-100
member groups which had self-insurance with stop-loss coverage as of
June 1st, 2015, as long as they kept their coverage in effect The bill
contained a sunset five years in the future. This bill would amend the
chapter of the laws of 2015 that resulted from that legislation to
shorten the sunset to two years and to require the Department of
Financial Services to study stop-loss, so that the effect of allowing
the sale of stop-loss on the rates in the small group market may be
determined.

LEGISLATIVE HISTORY: New Bill.

FISCAL IMPLICATIONS: Undetermined.

EFFECTIVE DATE: Immediate, and shall take effect on the same date and
in the same manner as A 8134A and S 5928A of 2015

2015-S6004 (ACTIVE) - Bill Text download pdf

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

                                  6004

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                              June 19, 2015
                               ___________

Introduced  by  Sen.  SEWARD -- read twice and ordered printed, and when
  printed to be committed to the Committee on Rules

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

S. 6004                             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,

S. 6004                             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.

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