S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    172
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 9, 2019
                                ___________
 
 Introduced  by  M.  of A. CAHILL, GARBARINO, STIRPE, HEVESI, MAGNARELLI,
   ZEBROWSKI, STECK, QUART, RAIA, FRIEND, KOLB -- Multi-Sponsored  by  --
   M. of A.  FITZPATRICK, STEC -- read once and referred to the Committee
   on Insurance

 AN  ACT  to amend the insurance law, in relation to rating of individual
   and small group health insurance contracts and policies
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph 1 of subsection (a) of section 3231 of the insur-
 ance  law,  as amended by section 69 of part D of chapter 56 of the laws
 of 2013, is amended to read as follows:
   (1) No individual health insurance policy and no group  health  insur-
 ance  policy  covering between one and fifty employees or members of the
 group, EXCEPT AS SET FORTH IN SUBSECTION (H) OF THIS SECTION, or between
 one and one hundred employees or  members  of  the  group  for  policies
 issued or renewed on or after January first, two thousand sixteen exclu-
 sive  of  spouses  and  dependents,  hereinafter  referred to as a small
 group, providing hospital and/or medical  benefits,  including  medicare
 supplemental insurance, shall be issued in this state unless such policy
 is community rated and, notwithstanding any other provisions of law, the
 underwriting  of  such  policy involves no more than the imposition of a
 pre-existing condition limitation if otherwise permitted by  this  arti-
 cle.
   §  2.  Paragraph  1 of subsection (h) of section 3231 of the insurance
 law, as amended by chapter 12 of the laws of 2016, 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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD01889-01-9

 A. 172                              2
 
 ance,  would  be  subject  to  this section. No insurer 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: (A) the
 renewal of stop loss, catastrophic or reinsurance coverage issued and in
 effect on January first, two thousand fifteen to small  groups  covering
 between fifty-one and one hundred employees or members of the group; and
 (B)  the issuance between January first, two thousand sixteen and Decem-
 ber thirty-first, two thousand sixteen, of stop  loss,  catastrophic  or
 reinsurance coverage, and any renewal thereof, to a small group covering
 between  fifty-one  and  one  hundred employees or members of the group,
 provided that such group had  stop  loss,  catastrophic  or  reinsurance
 coverage  issued  and  in effect on January first, two thousand fifteen.
 FOR PURPOSES OF THIS  SUBSECTION,  "SMALL  GROUP"  SHALL  MEAN  A  GROUP
 COMPRISED  OF  BETWEEN  ONE AND FIFTY EMPLOYEES OR MEMBERS, EXCLUSIVE OF
 SPOUSES AND DEPENDENTS.
   § 3. Paragraph 1 of subsection (h) of section 3231  of  the  insurance
 law,  as added by chapter 501 of the laws of 1992, 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. FOR PURPOSES
 OF THIS SUBSECTION, "SMALL  GROUP"  SHALL  MEAN  A  GROUP  COMPRISED  OF
 BETWEEN  ONE  AND  FIFTY  EMPLOYEES OR MEMBERS, EXCLUSIVE OF SPOUSES AND
 DEPENDENTS.
   § 4. Paragraph 1 of subsection (a) of section 4317  of  the  insurance
 law,  as  amended  by  section 72 of part D of chapter 56 of the laws of
 2013, is amended to read as follows:
   (1) No individual health insurance contract and no group health insur-
 ance contract covering between one and fifty employees or members of the
 group, EXCEPT AS SET FORTH IN SUBSECTION (E) OF THIS SECTION, or between
 one and one hundred employees or  members  of  the  group  for  policies
 issued or renewed on or after January first, two thousand sixteen exclu-
 sive of spouses and dependents, including contracts for which the premi-
 ums  are  paid by a remitting agent for a group, hereinafter referred to
 as a small group, providing hospital and/or medical benefits,  including
 Medicare  supplemental  insurance,  shall be issued in this state unless
 such  contract  is  community  rated  and,  notwithstanding  any   other
 provisions  of  law,  the underwriting of such contract involves no more
 than the imposition of a pre-existing condition limitation if  otherwise
 permitted by this article.
   §  5.  Paragraph  1 of subsection (e) of section 4317 of the insurance
 law, as amended by chapter 12 of the laws of 2016, 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 may provide stop
 loss, catastrophic or reinsurance coverage to  small  groups  which,  if
 they  purchased  insurance,  would be subject to this section. Provided,

 A. 172                              3

 however, the provisions of this paragraph shall not apply  to:  (A)  the
 renewal of stop loss, catastrophic or reinsurance coverage issued and in
 effect  on  January first, two thousand fifteen to small groups covering
 between fifty-one and one hundred employees or members of the group; and
 (B) the issuance between January first, two thousand sixteen, and Decem-
 ber  thirty-first,  two  thousand sixteen, of stop loss, catastrophic or
 reinsurance coverage, and any renewal thereof, to a small group covering
 between fifty-one and one hundred employees or  members  of  the  group,
 provided  that  such  group  had  stop loss, catastrophic or reinsurance
 coverage issued and in effect on January first,  two  thousand  fifteen.
 FOR  PURPOSES  OF  THIS  SUBSECTION,  "SMALL  GROUP"  SHALL MEAN A GROUP
 COMPRISED OF BETWEEN ONE AND FIFTY EMPLOYEES OR  MEMBERS,  EXCLUSIVE  OF
 SPOUSES AND DEPENDENTS.
   §  6.  Paragraph  1 of subsection (e) of section 4317 of the insurance
 law, as amended by section 72 of part D of chapter 56  of  the  laws  of
 2013, 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.   FOR
 PURPOSES OF THIS SUBSECTION, "SMALL GROUP" SHALL MEAN A GROUP  COMPRISED
 OF  BETWEEN ONE AND FIFTY EMPLOYEES OR MEMBERS, EXCLUSIVE OF SPOUSES AND
 DEPENDENTS.
   § 7. This act shall take effect  immediately;  provided,  however  the
 amendments  to  paragraph  1  of  subsection  (h) of section 3231 of the
 insurance law made by section two of this act shall be  subject  to  the
 expiration  and  reversion  of  such  paragraph pursuant to section 5 of
 chapter 588 of the laws of 2015, as amended, when  upon  such  date  the
 provisions of section three of this act shall take effect; and provided,
 further, the amendments to paragraph 1 of subsection (e) of section 4317
 of  the  insurance law made by section five of this act shall be subject
 to the expiration and reversion of such paragraph pursuant to section  5
 of  chapter 588 of the laws of 2015, as amended, when upon such date the
 provisions of section six of this act shall take effect.