NY State Senate Bill 2023-S5890A

Current 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 22, 2023	approval memo.88 signed chap.768
Dec 12, 2023	delivered to governor
May 30, 2023	returned to senate passed assembly ordered to third reading rules cal.336 substituted for a2853b
May 22, 2023	referred to insurance returned to assembly repassed senate
May 16, 2023	amended on third reading 5890a
May 16, 2023	vote reconsidered - restored to third reading returned to senate recalled from assembly
May 08, 2023	referred to insurance delivered to assembly passed senate
Apr 26, 2023	advanced to third reading
Apr 25, 2023	2nd report cal.
Apr 24, 2023	1st report cal.631
Mar 21, 2023	referred to insurance

Votes

- May 22, 2023 - Floor Vote
  S5890A
  
  61
  
  Aye
  
  0
  
  Nay
  
  0
  
  Absent
  
  2
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: May 22, 2023
      
      aye (61)
      
      Addabbo Jr.
      
      Ashby
      
      Bailey
      
      Borrello
      
      Breslin
      
      Brisport
      
      Brouk
      
      Chu
      
      Cleare
      
      Comrie
      
      Cooney
      
      Felder
      
      Fernandez
      
      Gallivan
      
      Gianaris
      
      Gonzalez
      
      Gounardes
      
      Griffo
      
      Harckham
      
      Helming
      
      Hinchey
      
      Hoylman-Sigal
      
      Jackson
      
      Kavanagh
      
      Kennedy
      
      Krueger
      
      Lanza
      
      Liu
      
      Mannion
      
      Martinez
      
      Martins
      
      Mattera
      
      May
      
      Mayer
      
      Murray
      
      Myrie
      
      O'Mara
      
      Oberacker
      
      Ortt
      
      Palumbo
      
      Persaud
      
      Ramos
      
      Rhoads
      
      Rivera
      
      Rolison
      
      Ryan
      
      Salazar
      
      Sanders Jr.
      
      Scarcella-Spanton
      
      Sepúlveda
      
      Serrano
      
      Skoufis
      
      Stavisky
      
      Stec
      
      Stewart-Cousins
      
      Tedisco
      
      Thomas
      
      Walczyk
      
      Webb
      
      Weber
      
      Weik
      
      excused (2)
      
      Canzoneri-Fitzpatrick
      
      Parker
  May 8, 2023 - Floor Vote
  S5890A
  
  61
  
  Aye
  
  0
  
  Nay
  
  0
  
  Absent
  
  2
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: May 8, 2023
      
      aye (61)
      
      Addabbo Jr.
      
      Ashby
      
      Bailey
      
      Borrello
      
      Breslin
      
      Brisport
      
      Brouk
      
      Canzoneri-Fitzpatrick
      
      Chu
      
      Cleare
      
      Comrie
      
      Felder
      
      Fernandez
      
      Gallivan
      
      Gianaris
      
      Gonzalez
      
      Gounardes
      
      Griffo
      
      Harckham
      
      Helming
      
      Hinchey
      
      Hoylman-Sigal
      
      Jackson
      
      Kavanagh
      
      Kennedy
      
      Krueger
      
      Lanza
      
      Liu
      
      Mannion
      
      Martinez
      
      Martins
      
      Mattera
      
      May
      
      Mayer
      
      Murray
      
      Myrie
      
      O'Mara
      
      Oberacker
      
      Ortt
      
      Palumbo
      
      Persaud
      
      Ramos
      
      Rhoads
      
      Rivera
      
      Rolison
      
      Ryan
      
      Salazar
      
      Sanders Jr.
      
      Scarcella-Spanton
      
      Sepúlveda
      
      Serrano
      
      Skoufis
      
      Stavisky
      
      Stec
      
      Stewart-Cousins
      
      Tedisco
      
      Thomas
      
      Walczyk
      
      Webb
      
      Weber
      
      Weik
      
      excused (2)
      
      Cooney
      
      Parker
  Apr 24, 2023 - Insurance Committee Vote
  S5890A
  
  10
  
  Aye
  
  0
  
  Nay
  
  0
  
  Aye with Reservations
  
  1
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Insurance Committee Vote: Apr 24, 2023
      
      aye (10)
      
      Addabbo Jr.
      
      Borrello
      
      Breslin
      
      Cooney
      
      Harckham
      
      Helming
      
      Kennedy
      
      Martinez
      
      Sanders Jr.
      
      Scarcella-Spanton
      
      absent (1)
      
      O'Mara

Bill Amendments

Original

A (Active)

co-Sponsors

2023-S5890 - Details

See Assembly Version of this Bill:: A2853
Law Section:: Insurance Law
Laws Affected:: Amd §3239, Ins L
Versions Introduced in 2021-2022 Legislative Session:: S4329, A8617

2023-S5890 - Summary

Authorizes life insurers to establish wellness programs in conjunction with the issuance of life insurance policies; provides for full or partial reimbursement for the cost of a device and associated subscription that can be used to track activity or biometric data; provides for discounts on life insurance and on products or services intended to incent positive behavioral changes.

2023-S5890 - Sponsor Memo

                                 
BILL NUMBER: S5890

SPONSOR: BRESLIN
 
TITLE OF BILL:

An act to amend the insurance law, in relation to authorizing life
insurers to establish wellness programs

 
PURPOSE:

To prohibit insurers from reducing long-term disability insurance bene-
fits for estimated benefits provided under the federal Social Security
Disability Insurance Program unless certain conditions are met.

 
SUMMARY OF PROVISIONS:

Section 1 adds a new subsection (n) to § 3216 of the Insurance Law which
expressly prohibit insurers from issuing or delivering a policy or
certificate for accident and health insurance providing disability bene-
fits that authorizes an insurer to offset or reduce benefits due to the
actual or reasonably expected eligibility for social security disability
benefits or other disability benefits, unless such policy or certificate

notifies the insured that insured may qualify for such benefits, and to
pursue such benefits through any required administrative appeals; and a
new subsection (o) which provides that no insurer may offset or reduce
benefits payable under a policy of accident and health insurance provid-
ing disability insurance due to the actual or reasonably expected eligi-
bility for social security disability insurance benefits unless: (1) the
insurer has a reasonable, good faith belief that the insured is entitled
to such benefits and a means of reasonably estimating the amount paya-
ble; (2) the insurer makes a good faith effort to assist the insured in
applying for such benefits; and (3) the insured fails to apply for, or
pursue, such benefits with reasonable diligence during the application
process or any required appeals.

Section 2 provides that this act shall take effect immediately.

 
JUSTIFICATION:

Social Security Disability Insurance is a federal benefit which provides
benefits to individuals who have worked jobs covered by Social Security
and have an inability to do any substantial gainful activity by reason
of any medically determinable physical or mental impairment which can be
expected to result in death or which has lasted or can be expected to
last for a continuous period of not less than 12 months.

As a matter of sound public policy, it is critical that New York encour-
age its residents to take full advantage of the federal benefits they
are entitled to, including Social Security Disability Insurance
("SSDI"). The benefits of SSDI are numerous and New York residents
should not go without the many advantages this federal program provides.
All too often New Yorkers are on the losing side of the equation when it
comes to resources provided from Washington.

Providing clear requirements as to when insurers are permitted to deduct
estimated SSDI benefit payments from long-term disability ("LTD") insur-
ance payments will encourage more policyholders to take advantage of
their substantial federal benefits.

There are numerous benefits, beyond the financial benefit itself, that
individuals and their families entitled to SSDI receive under the SSDI
program. As eligible workers have earned this benefit by contributing
6.2% (on top of 6.2% from the employer) of their earnings through the
Federal Insurance Contributions Act ("FICA") to fund Social Security,
including disability insurance, it is only right that they are encour-
aged to take advantage of all of the program's benefit.

The following are benefits received under Social Security Disability
Insurance:

* SSDI freezes the individual's Social Security earnings records, which
means that the amount of eventual retirement benefit may be substantial-
ly higher (depending on when someone is disabled). The normal Social
Security Retirement 35-year average earnings is adjusted for years on
disability, which for the average SSDI beneficiary could lead to a
substantially higher retirement benefit.  The impact of having zero
earnings considered for a given year can be dramatic. If an SSDI eligi-
ble claimant remains solely on an LTD plan, the 35-year average earnings
will be significantly lower due to the disability period, leading to a
reduce retirement benefit.

* SSDI provides spousal and child benefits to those eligible. On aver-
age, the SSDI benefit amounts to $415 for spouses and $390 for children
that would not be available to private long-term disability only claim-
ants.

* Individuals entitled to SSDI are eligible for Medicare coverage after
24 months, allowing for medical services at reduced health insurance
premiums. Some disabling conditions waive the 24-month waiting period
and grant immediate Medicare coverage. SSDI eligibility also increases
extension of employer sponsored medical coverage under COBRA (bridges
COBRA to Medicare).

* Individuals taking advantage of the SSDI program may be entitled to
significant tax savings (SSDI benefit vs a taxable long-term disability
benefit).

* There is the potential for a closed period award (a closed period
exists when a claimant for Social Security disability benefits or SSI is
found to be ineligible for ongoing benefits, but yet eligible to receive
benefits for a period of time in the past).

* SSDI provides the ability to participate in a work trial period (9
months without losing SSDI and potential re-training through the SSA's
"Ticket to Work program").

* Cost of living adjustments made to the SSDI benefits would not be
deducted from the private longterm disability benefit payments, and
therefore, would go directly to the disabled resident. This is one of
the most significant benefits which can lead to substantial increases in
income over time.

In addition to missing out on the many benefits that an individual disa-
bled claimant may be entitled to, the prohibition that insurers are no
longer permitted to deduct LTD disability insurance benefit payments for
estimated SSDI benefits, has a negative impact on the offering and pric-
ing of disability benefits in the state. With this interpretation, New
York is the only state to prohibit the practice of estimating SSDI bene-
fits by allowing carriers to offset for benefits actually received while
also prohibiting carriers from requiring claimants to appeal for SSDI
benefits or appeal adverse determinations. As a result, all premium
ratepayers are negatively impacted by higher pricing due to the reluc-
tance of the few individuals who actively choose to not seek the federal
benefits they are entitled to.

 
LEGISLATIVE HISTORY:

This is a new bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S5890 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5890
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                              March 21, 2023
                                ___________
 
 Introduced  by  Sen. BRESLIN -- 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  authorizing  life
   insurers to establish wellness programs
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 3239 of the insurance law, as added by chapter  592
 of  the  laws  of 2008 and subsections (b) and (c) as amended by chapter
 180 of the laws of 2016, is amended to read as follows:
   § 3239. Wellness programs. (a)  An  insurer  licensed  to  write  LIFE
 INSURANCE MAY ESTABLISH A WELLNESS PROGRAM IN CONJUNCTION WITH ITS ISSU-
 ANCE  OF  LIFE INSURANCE POLICIES AND AN INSURER LICENSED TO WRITE acci-
 dent and health insurance, a corporation organized pursuant  to  article
 forty-three of this chapter, a health maintenance organization certified
 pursuant  to article forty-four of the public health law and a municipal
 cooperative health benefits plan may establish  a  wellness  program  in
 conjunction  with  its issuance of a group accident and health insurance
 policy or group subscriber contract. A "wellness program" is  a  program
 designed  to promote health [and], LONGEVITY OR prevent disease that may
 contain rewards and incentives for participation. Participation  in  the
 wellness program shall be available to similarly-situated members of the
 group OR WITH REGARD TO  LIFE INSURANCE, TO ALL INSUREDS WITHIN THE SAME
 CLASS  IN  A  MANNER  THAT  IS  NOT UNFAIRLY DISCRIMINATORY and shall be
 voluntary on the part of the member OR INSURED.   WITH  REGARD  TO  LIFE
 INSURANCE,  AN INSURER IS PROHIBITED FROM INCREASING PREMIUMS OR CHARGES
 STATED IN THE POLICY AS A RESULT OF PARTICIPATION  OR  NON-PARTICIPATION
 IN  THE PROGRAM. The terms of the wellness program shall be set forth in
 the policy or contract.
   (b) A wellness program may include, but is not limited to, the follow-
 ing programs or services:
   (1) the use of a health risk assessment tool;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD07895-02-3

 S. 5890                             2
 
   (2) a smoking cessation program;
   (3) a weight management program;
   (4) a stress and/or hypertension management program;
   (5) a worker injury prevention program;
   (6) a nutrition education program;
   (7) health or fitness incentive programs;
   (8)  a coordinated weight management, nutrition, stress management and
 physical fitness program to combat  the  high  incidence  of  adult  and
 childhood obesity, asthma and other chronic respiratory conditions;
   (9) a substance or alcohol abuse cessation program; [and]
   (10) a program to manage and cope with chronic pain;
   (11)  A  PREVENTATIVE  CARE, SCREENINGS, OR CHRONIC DISEASE MANAGEMENT
 PROGRAM; AND
   (12) A MEDITATION, SLEEP IMPROVEMENT OR SIMILAR PROGRAM OR SERVICE.
   (c)(1) A wellness program may use rewards and incentives  for  partic-
 ipation  provided  that  where  the  group  health  insurance  policy or
 subscriber contract is required to be community-rated, the  rewards  and
 incentives  shall  not  include a discounted premium rate or a rebate or
 refund of premium.
   (2) Permissible rewards and incentives may include:
   (A) full or partial reimbursement of  the  cost  of  participating  in
 smoking cessation, weight management, stress and/or hypertension, worker
 injury  prevention,  nutrition  education,  substance  or  alcohol abuse
 cessation, PREVENTATIVE CARE PROGRAMS, OR  SCREENINGS,  CHRONIC  DISEASE
 MANAGEMENT PROGRAMS, or chronic pain management and coping programs;
   (B)  full  or  partial  reimbursement  of  the cost of membership in a
 health club or fitness center;
   (C) (1) the waiver or reduction of copayments, coinsurance and deduct-
 ibles for preventive services covered under the group  HEALTH  INSURANCE
 policy or subscriber contract;
   (2)  A  PREMIUM  REFUND,  DISCOUNT OR POLICY VALUE CREDIT UNDER A LIFE
 INSURANCE POLICY;
   (D) monetary rewards in the form of  gift  cards  [or],  gift  certif-
 icates, [so long as the recipient of the reward is encouraged to use the
 reward  for  a  product  or a service that promotes good health, such as
 healthy cook books, over the counter  vitamins  or  exercise  equipment]
 VOUCHERS  OR  DISCOUNTS  ON  PRODUCTS  OR  SERVICES THAT ARE INTENDED TO
 INCENT BEHAVIORAL CHANGES THAT IMPROVE THE HEALTH OR REDUCE THE RISK  OF
 DEATH OF THE INSURED;
   (E)  full  or  partial reimbursement of the cost of participating in a
 stress management program or  activity,  INCLUDING  PARTICIPATION  IN  A
 MEDITATION,  SLEEP  IMPROVEMENT  OR SIMILAR PROGRAM OR SERVICE, PROVIDED
 THAT SUCH PROGRAM OR ACTIVITY SHALL BE BASED ON DATA AND  RESEARCH  THAT
 THE  PROGRAM  OR SERVICE CAN BE REASONABLY EXPECTED TO RESULT IN OVERALL
 GOOD HEALTH, WELL BEING, OR IMPROVED MORTALITY RISK; [and]
   (F) full or partial reimbursement of the cost of  participating  in  a
 health or fitness program;
   (G) FULL OR PARTIAL REIMBURSEMENT OF THE COST OF A WEARABLE DEVICE AND
 ANY  ASSOCIATED  SUBSCRIPTION MEMBERSHIP THAT CAN BE USED TO TRACK PHYS-
 ICAL ACTIVITY OR BIOMETRIC DATA, AND WHICH INCENTS BEHAVIORAL CHANGES TO
 IMPROVE THE HEALTH OR REDUCE THE RISK OF DEATH OF THE INSURED; AND
   (H) FULL OR PARTIAL REIMBURSEMENT OF BIOMETRIC SCREENINGS.
   (3) Where the reward involves a group  member's  meeting  a  specified
 standard  based  on  a  health  condition,  the wellness program UNDER A
 HEALTH INSURANCE POLICY must meet the requirements of 45 CFR Part 146.
 S. 5890                             3
 
   (4) A reward or incentive which involves a discounted premium rate  or
 a  rebate  or refund of premium UNDER A HEALTH INSURANCE POLICY shall be
 based on actuarial demonstration that the wellness program  can  reason-
 ably  be expected to result in the overall good health and well being of
 the group. A REWARD OR INCENTIVE THAT INVOLVES A DISCOUNTED PREMIUM RATE
 OR  REBATE  OR  REFUND OF PREMIUM UNDER A LIFE INSURANCE POLICY SHALL BE
 ACTUARIALLY SUPPORTED BY DATA  AND  RESEARCH  THAT  SUCH  INCENTIVES  OR
 REWARDS,  IN  THE  AGGREGATE,  ARE  DIRECTED  TO  SHARING THE BENEFIT OF
 IMPROVING  EXPECTED  MORTALITY  RISK  EXPERIENCE.    DATA  COLLECTED  IN
 CONNECTION  WITH  A  WELLNESS  PROGRAM SHALL BE SUBJECT TO ALL STATE AND
 FEDERAL PRIVACY AND SECURITY LAWS.
   § 2. This act shall take effect immediately.

co-Sponsors

2023-S5890A (ACTIVE) - Details

See Assembly Version of this Bill:: A2853
Law Section:: Insurance Law
Laws Affected:: Amd §3239, Ins L
Versions Introduced in 2021-2022 Legislative Session:: S4329, A8617

2023-S5890A (ACTIVE) - Summary

2023-S5890A (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S5890A

SPONSOR: BRESLIN
 
TITLE OF BILL:

An act to amend the insurance law, in relation to authorizing life
insurers to establish wellness programs

 
PURPOSE:

To prohibit insurers from reducing long-term disability insurance bene-
fits for estimated benefits provided under the federal Social

Security Disability Insurance Program unless certain conditions are met.

 
SUMMARY OF PROVISIONS:

Section 1 adds a new subsection (n) to § 3216 of the Insurance Law which
expressly prohibit insurers from issuing or delivering a policy or
certificate for accident and health insurance providing disability bene-
fits that authorizes an insurer to offset or reduce benefits due to the
actual or reasonably expected eligibility for social security disability

benefits or other disability benefits, unless such policy or certificate
notifies the insured that insured may qualify for such benefits, and to
pursue such benefits through any required administrative appeals; and a
new subsection (o) which provides that no insurer may offset or reduce
benefits payable under a policy of accident and health insurance provid-
ing disability insurance due to the actual or reasonably expected eligi-
bility for social security disability insurance benefits unless: (1) the
insurer has a reasonable, good faith belief that the insured is entitled
to such benefits and a means of reasonably estimating the amount paya-
ble; (2) the insurer makes a good faith effort to assist the insured in
applying for such benefits; and (3) the insured fails to apply for, or
pursue, such benefits with reasonable diligence during the application
process or any required appeals.

Section 2 provides that this act shall take effect immediately.

 
JUSTIFICATION:

Social Security Disability Insurance is a federal benefit which provides
benefits to individuals who have worked jobs covered by Social Security
and have an inability to do any substantial gainful activity by reason
of any medically determinable physical or mental impairment which can be
expected to result in death or which has lasted or can be expected to
last for a continuous period of not less than 12 months.

As a matter of sound public policy, it is critical that New York encour-
age its residents to take full advantage of the federal benefits they
are entitled to, including Social Security Disability Insurance
("SSDI"). The benefits of SSDI are numerous and New York residents
should not go without the many advantages this federal program provides.
All too often New Yorkers are on the losing side of the equation when it
comes to resources provided from Washington.

Providing clear requirements as to when insurers are permitted to deduct
estimated SSDI benefit payments from long-term disability ("LTD") insur-
ance payments will encourage more policyholders to take advantage of
their substantial federal benefits.
There are numerous benefits, beyond the financial benefit itself, that
individuals and their families entitled to SSDI receive under the SSDI
program. As eligible workers have earned this benefit by contributing
6.2% (on top of 6.2% from the employer) of their earnings through the
Federal Insurance Contributions Act ("FICA") to fund Social Security,
including disability insurance, it is only right that they are encour-
aged to take advantage of all of the program's benefit.

The following are benefits received under Social Security Disability
Insurance:

* SSDI freezes the individual's Social Security earnings records, which
means that the amount of eventual retirement benefit may be substantial-
ly higher (depending on when someone is disabled). The normal Social
Security Retirement 35-year average earnings is adjusted for years on
disability, which for the average SSDI beneficiary could lead to a
substantially higher retirement benefit.  The impact of having zero
earnings considered for a given year can be dramatic. If an SSDI eligi-
ble claimant remains solely on an LTD plan, the 35-year average earnings
will be significantly lower due to the disability period, leading to a
reduce retirement benefit.

* SSDI provides spousal and child benefits to those eligible. On aver-
age, the SSDI benefit amounts to $415 for spouses and $390 for children
that would not be available to private long-term disability only claim-
ants.

* Individuals entitled to SSDI are eligible for Medicare coverage after
24 months, allowing for medical services at reduced health insurance
premiums. Some disabling conditions waive the 24-month waiting period
and grant immediate Medicare coverage. SSDI eligibility also increases
extension of employer sponsored medical coverage under COBRA (bridges
COBRA to Medicare).

* Individuals taking advantage of the SSDI program may be entitled to
significant tax savings (SSDI benefit vs a taxable long-term disability
benefit).

* There is the potential for a closed period award (a closed period
exists when a claimant for Social Security disability benefits or SSI is
found to be ineligible for ongoing benefits, but yet eligible to receive
benefits for a period of time in the past).

* SSDI provides the ability to participate in a work trial period (9
months without losing SSDI and potential re-training through the SSA's
"Ticket to Work program").

* Cost of living adjustments made to the SSDI benefits would not be
deducted from the private longterm disability benefit payments, and
therefore, would go directly to the disabled resident. This is one of
the most significant benefits which can lead to substantial increases in
income over time.

In addition to missing out on the many benefits that an individual disa-
bled claimant may be entitled to, the prohibition that insurers are no
longer permitted to deduct LTD disability insurance benefit payments for
estimated SSDI benefits, has a negative impact on the offering and pric-
ing of disability benefits in the state. With this interpretation, New
York is the only state to prohibit the practice of estimating SSDI bene-
fits by allowing carriers to offset for benefits actually received while
also prohibiting carriers from requiring claimants to appeal for SSDI
benefits or appeal adverse determinations. As a result, all premium
ratepayers are negatively impacted by higher pricing due to the reluc-
tance of the few individuals who actively choose to not seek the federal
benefits they are entitled to.

 
LEGISLATIVE HISTORY:

This is a new bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
This act shall take effect immediately.

2023-S5890A (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5890--A
     Cal. No. 631
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                              March 21, 2023
                                ___________
 
 Introduced  by  Sens.  BRESLIN,  FERNANDEZ,  GOUNARDES -- read twice and
   ordered printed, and when printed to be committed to the Committee  on
   Insurance  -- reported favorably from said committee, ordered to first
   and second report, ordered to a third reading, passed  by  Senate  and
   delivered  to  the  Assembly, recalled, vote reconsidered, restored to
   third reading, amended and ordered reprinted, retaining its  place  in
   the order of third reading
 
 AN  ACT  to  amend  the  insurance  law, in relation to authorizing life
   insurers to establish wellness programs
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. Section 3239 of the insurance law, as added by chapter 592
 of the laws of 2008 and subsections (b) and (c) as  amended  by  chapter
 180 of the laws of 2016, is amended to read as follows:
   §  3239.  Wellness  programs.  (a)  An  insurer licensed to write LIFE
 INSURANCE MAY ESTABLISH A WELLNESS PROGRAM IN CONJUNCTION WITH ITS ISSU-
 ANCE OF LIFE INSURANCE POLICIES AND AN INSURER LICENSED TO  WRITE  acci-
 dent  and  health insurance, a corporation organized pursuant to article
 forty-three of this chapter, a health maintenance organization certified
 pursuant to article forty-four of the public health law and a  municipal
 cooperative  health  benefits  plan  may establish a wellness program in
 conjunction with its issuance of a group accident and  health  insurance
 policy  or  group subscriber contract. A "wellness program" is a program
 designed to promote health [and], LONGEVITY OR prevent disease that  may
 contain  rewards  and incentives for participation. Participation in the
 wellness program shall be available to similarly-situated members of the
 group OR WITH REGARD TO  LIFE INSURANCE, TO ALL INSUREDS WITHIN THE SAME
 CLASS IN A MANNER THAT IS  NOT  UNFAIRLY  DISCRIMINATORY  and  shall  be
 voluntary  on  the  part  of the member OR INSURED.  WITH REGARD TO LIFE
 INSURANCE, AN INSURER IS PROHIBITED FROM INCREASING PREMIUMS OR  CHARGES
 STATED  IN  THE POLICY AS A RESULT OF PARTICIPATION OR NON-PARTICIPATION
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD07895-04-3
 S. 5890--A                          2
 
 IN THE PROGRAM. The terms of the wellness program shall be set forth  in
 the policy or contract.
   (b) A wellness program may include, but is not limited to, the follow-
 ing programs or services:
   (1) the use of a health risk assessment tool;
   (2) a smoking cessation program;
   (3) a weight management program;
   (4) a stress and/or hypertension management program;
   (5) a worker injury prevention program;
   (6) a nutrition education program;
   (7) health or fitness incentive programs;
   (8)  a coordinated weight management, nutrition, stress management and
 physical fitness program to combat  the  high  incidence  of  adult  and
 childhood obesity, asthma and other chronic respiratory conditions;
   (9) a substance or alcohol abuse cessation program; [and]
   (10) a program to manage and cope with chronic pain;
   (11)  A  PREVENTATIVE  CARE, SCREENINGS, OR CHRONIC DISEASE MANAGEMENT
 PROGRAM; AND
   (12) A MEDITATION, SLEEP IMPROVEMENT OR SIMILAR PROGRAM OR SERVICE.
   (c)(1) A wellness program may use rewards and incentives  for  partic-
 ipation  provided  that  where  the  group  health  insurance  policy or
 subscriber contract is required to be community-rated, the  rewards  and
 incentives  shall  not  include a discounted premium rate or a rebate or
 refund of premium.
   (2) Permissible rewards and incentives may include:
   (A) full or partial reimbursement of  the  cost  of  participating  in
 smoking cessation, weight management, stress and/or hypertension, worker
 injury  prevention,  nutrition  education,  substance  or  alcohol abuse
 cessation, PREVENTATIVE CARE PROGRAMS, OR  SCREENINGS,  CHRONIC  DISEASE
 MANAGEMENT PROGRAMS, or chronic pain management and coping programs;
   (B)  full  or  partial  reimbursement  of  the cost of membership in a
 health club or fitness center;
   (C) (1) the waiver or reduction of copayments, coinsurance and deduct-
 ibles for preventive services covered under the group  HEALTH  INSURANCE
 policy or subscriber contract;
   (2)  A  PREMIUM  REFUND,  DISCOUNT,  OR  POLICY VALUE CREDIT, OR OTHER
 INCREASE IN BENEFITS OR DECREASE IN CHARGES UNDER A LIFE INSURANCE POLI-
 CY;
   (D) monetary rewards in the form of  gift  cards  [or],  gift  certif-
 icates, [so long as the recipient of the reward is encouraged to use the
 reward  for  a  product  or a service that promotes good health, such as
 healthy cook books, over the counter  vitamins  or  exercise  equipment]
 VOUCHERS  OR  DISCOUNTS  ON  PRODUCTS  OR  SERVICES THAT ARE INTENDED TO
 INCENT BEHAVIORAL CHANGES THAT IMPROVE THE HEALTH OR REDUCE THE RISK  OF
 DEATH OF THE INSURED;
   (E)  full  or  partial reimbursement of the cost of participating in a
 stress management program or  activity,  INCLUDING  PARTICIPATION  IN  A
 MEDITATION,  SLEEP  IMPROVEMENT  OR SIMILAR PROGRAM OR SERVICE, PROVIDED
 THAT SUCH PROGRAM OR ACTIVITY SHALL BE BASED ON DATA AND  RESEARCH  THAT
 THE  PROGRAM  OR SERVICE CAN BE REASONABLY EXPECTED TO RESULT IN OVERALL
 GOOD HEALTH, WELL BEING, OR IMPROVED MORTALITY RISK; [and]
   (F) full or partial reimbursement of the cost of  participating  in  a
 health or fitness program;
   (G) FULL OR PARTIAL REIMBURSEMENT OF THE COST OF A WEARABLE DEVICE AND
 ANY  ASSOCIATED  SUBSCRIPTION MEMBERSHIP THAT CAN BE USED TO TRACK PHYS-
 S. 5890--A                          3

 ICAL ACTIVITY OR BIOMETRIC DATA, AND WHICH INCENTS BEHAVIORAL CHANGES TO
 IMPROVE THE HEALTH OR REDUCE THE RISK OF DEATH OF THE INSURED; AND
   (H) FULL OR PARTIAL REIMBURSEMENT OF BIOMETRIC SCREENINGS.
   (3)  Where  the  reward  involves a group member's meeting a specified
 standard based on a health  condition,  the  wellness  program  UNDER  A
 HEALTH INSURANCE POLICY must meet the requirements of 45 CFR Part 146.
   (4)  A reward or incentive which involves a discounted premium rate or
 a rebate or refund of premium UNDER A HEALTH INSURANCE POLICY  shall  be
 based  on  actuarial demonstration that the wellness program can reason-
 ably be expected to result in the overall good health and well being  of
 the group. A REWARD OR INCENTIVE THAT INVOLVES A DISCOUNTED PREMIUM RATE
 OR  REBATE  OR  REFUND OF PREMIUM UNDER A LIFE INSURANCE POLICY SHALL BE
 ACTUARIALLY SUPPORTED BY DATA  AND  RESEARCH  THAT  SUCH  INCENTIVES  OR
 REWARDS,  IN  THE  AGGREGATE,  ARE  DIRECTED  TO  SHARING THE BENEFIT OF
 IMPROVING  EXPECTED  MORTALITY  RISK  EXPERIENCE.    DATA  COLLECTED  IN
 CONNECTION  WITH  A  WELLNESS  PROGRAM SHALL BE SUBJECT TO ALL STATE AND
 FEDERAL PRIVACY AND SECURITY LAWS.
   § 2. This act shall take effect immediately.

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Senate Bill S5890A

Sponsored By

Current Bill Status - Signed by Governor

May 22, 2023 - Floor Vote

Floor Vote: May 22, 2023

May 8, 2023 - Floor Vote

Floor Vote: May 8, 2023

Apr 24, 2023 - Insurance Committee Vote

Insurance Committee Vote: Apr 24, 2023

Bill Amendments

co-Sponsors

2023-S5890 - Details

2023-S5890 - Summary

2023-S5890 - Sponsor Memo

2023-S5890 - Bill Text download pdf

co-Sponsors

2023-S5890A (ACTIVE) - Details

2023-S5890A (ACTIVE) - Summary

2023-S5890A (ACTIVE) - Sponsor Memo

2023-S5890A (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S5890A

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Sponsored By

Neil D. Breslin

Current Bill Status - Signed by Governor

Bill Amendments

co-Sponsors

Nathalia Fernandez

Andrew Gounardes

2023-S5890 - Details

2023-S5890 - Summary

2023-S5890 - Sponsor Memo

2023-S5890 - Bill Text download pdf

co-Sponsors

Nathalia Fernandez

Andrew Gounardes

2023-S5890A (ACTIVE) - Details

2023-S5890A (ACTIVE) - Summary

2023-S5890A (ACTIVE) - Sponsor Memo

2023-S5890A (ACTIVE) - Bill Text download pdf

Comments