S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5326
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             February 20, 2025
                                ___________
 
 Introduced  by  Sen.  BAILEY -- 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  standardized  health
   insurance  contracts for small dental employers; and providing for the
   repeal of such provisions upon the expiration thereof

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The section heading and subsections (a), (c), (g), (h), (i)
 and  (k)  of section 4326 of the insurance law, as amended by section 56
 of part D of chapter 56 of the laws of 2013,  are  amended  to  read  as
 follows:
   Standardized   health   insurance   contracts   for  qualifying  small
 employers, QUALIFYING SMALL DENTAL  EMPLOYERS  and  individuals.  (a)  A
 program  is  hereby  established  for the purpose of making standardized
 health insurance contracts available to qualifying small  employers  AND
 QUALIFYING  SMALL  DENTAL  EMPLOYERS  as  defined  in this section. Such
 program is designed to encourage small employers to offer health  insur-
 ance coverage to their employees.
   (c)  The  following  definitions  shall be applicable to the insurance
 contracts offered under the program established by this section:
   (1) (A) A qualifying small employer is an employer with:
   (i) not more than fifty employees;
   (ii) no group health insurance that provides benefits  on  an  expense
 reimbursed  or  prepaid  basis  covering  employees in effect during the
 twelve month period prior to application for a qualifying  group  health
 insurance contract under the program established by this section; and
   (iii)  at least thirty percent of its employees receiving annual wages
 from the employer at a level equal  to  or  less  than  thirty  thousand
 dollars.  The  thirty  thousand  dollar figure shall be adjusted period-
 ically pursuant to subparagraph (D) of this paragraph.
   (B) The twelve month period set forth in item (ii) of subparagraph (A)
 of this paragraph may be adjusted  by  the  superintendent  from  twelve
 months  to  eighteen  months  if [he determines] THEY DETERMINE that the
 twelve month period is insufficient  to  prevent  inappropriate  substi-
 
              

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09809-01-5
 S. 5326                             2
 
 tution  of  qualifying group health insurance contracts for other health
 insurance contracts.
   (C)  An  employer shall cease to be a qualifying small employer if any
 health insurance that provides benefits  on  an  expense  reimbursed  or
 prepaid  basis  covering  an employer's employees, other than qualifying
 group health insurance purchased pursuant to this section, is  purchased
 or  otherwise  takes  effect  subsequent to purchase of qualifying group
 health insurance under the program established by this section.
   (D) The wage levels utilized in subparagraph  (A)  of  this  paragraph
 shall  be  adjusted annually, beginning in two thousand two. The adjust-
 ment shall take effect on July first of each year. For July  first,  two
 thousand  two,  the  adjustment shall be a percentage of the annual wage
 figure specified in subparagraph (A) of this paragraph.  For  subsequent
 years,  the  adjustment  shall be a percentage of the annual wage figure
 that took effect on July first of the prior year. The percentage adjust-
 ment shall be the same percentage by which the current  year's  non-farm
 federal  poverty level, as defined and updated by the federal department
 of health and human services, for a family unit of four persons for  the
 forty-eight  contiguous  states  and  Washington, D.C., changed from the
 same level established for the prior year.
   (2) (A) A QUALIFYING SMALL DENTAL EMPLOYER IS AN EMPLOYER WITH:
   (I) NOT MORE THAN FIFTY EMPLOYEES;
   (II) AT LEAST ONE DENTIST LICENSED AS A DENTIST UNDER  SECTION  SIXTY-
 SIX  HUNDRED  FOUR OF THE EDUCATION LAW WHO PRACTICES GENERAL DENTISTRY,
 PROVIDED  THAT  SUCH  DENTIST,  AND  ANY  ADDITIONAL  DENTIST  SIMILARLY
 LICENSED  AND  PRACTICING GENERAL DENTISTRY WITH WHOM SUCH DENTIST PRAC-
 TICES IN THE SAME LOCATION, SHALL  EACH  PROVIDE  AT  LEAST  TEN  DENTAL
 OFFICE  VISITS PER MONTH TO PATIENTS RECEIVING MEDICAL ASSISTANCE COVER-
 AGE UNDER TITLE ELEVEN OF ARTICLE  FIVE  OF  THE  SOCIAL  SERVICES  LAW.
 DENTAL  OFFICE  VISITS  PROVIDED  TO  SUCH  PATIENTS  SHALL  INCLUDE ALL
 SERVICES  ROUTINELY  PROVIDED  TO  PATIENTS  AT  SUCH  OFFICE  LOCATION,
 PROVIDED  THAT THE SERVICES ARE COVERED BY THE PATIENT'S MEDICAL ASSIST-
 ANCE COVERAGE; AND
   (III) AT LEAST TWO DENTAL HYGIENISTS  LICENSED  AS  DENTAL  HYGIENISTS
 UNDER SECTION SIXTY-SIX HUNDRED NINE OF THE EDUCATION LAW.
   (B)  AN  EMPLOYER SHALL CEASE TO BE A QUALIFYING SMALL DENTAL EMPLOYER
 IF ANY HEALTH INSURANCE THAT PROVIDES BENEFITS ON AN EXPENSE  REIMBURSED
 OR PREPAID BASIS COVERING AN EMPLOYER'S EMPLOYEES, OTHER THAN QUALIFYING
 GROUP  HEALTH INSURANCE PURCHASED PURSUANT TO THIS SECTION, IS PURCHASED
 OR OTHERWISE TAKES EFFECT SUBSEQUENT TO  PURCHASE  OF  QUALIFYING  GROUP
 HEALTH INSURANCE UNDER THE PROGRAM ESTABLISHED BY THIS SECTION.
   (3)  A  qualifying group health insurance contract is a group contract
 purchased from a health maintenance organization, corporation or insurer
 by a qualifying small employer OR QUALIFYING SMALL DENTAL EMPLOYER  that
 provides  the  benefits set forth in subsection (d) of this section. The
 contract must insure not less than fifty percent of the employees.
   (g) A health maintenance organization,  corporation  or  insurer  must
 offer the benefit package without change or additional benefits. A qual-
 ifying  small  employer  OR  QUALIFYING  SMALL  DENTAL EMPLOYER shall be
 issued the benefit  package  in  a  qualifying  group  health  insurance
 contract.
   (h)  A  health  maintenance organization, corporation or insurer shall
 obtain from the employer written certification at the  time  of  initial
 application  and  annually  thereafter ninety days prior to the contract
 renewal date that such employer meets the requirements of  a  qualifying
 small  employer  OR  QUALIFYING  SMALL  DENTAL EMPLOYER pursuant to this
 S. 5326                             3
 
 section. A health maintenance organization, corporation or  insurer  may
 require  the  submission  of appropriate documentation in support of the
 certification.
   (i)  Applications for qualifying group health insurance contracts must
 be accepted from any  qualifying  small  employer  OR  QUALIFYING  SMALL
 DENTAL EMPLOYER at all times throughout the year. The superintendent, by
 regulation,  may  require health maintenance organizations, corporations
 or insurers to give  preference  to  qualifying  small  employers  whose
 employees  have  the  lowest  average  salaries  AND TO QUALIFYING SMALL
 DENTAL EMPLOYERS WHO SERVE MORE THAN THE THRESHOLD  NUMBER  OF  PATIENTS
 RECEIVING MEDICAL ASSISTANCE COVERAGE UNDER TITLE ELEVEN OF ARTICLE FIVE
 OF  THE  SOCIAL  SERVICES LAW AS IDENTIFIED IN ITEM (II) OF SUBPARAGRAPH
 (A) OF PARAGRAPH TWO OF SUBSECTION (C) OF THIS SECTION.
   (k) A qualifying small employer OR QUALIFYING  SMALL  DENTAL  EMPLOYER
 shall  elect  whether to make coverage under the qualifying group health
 insurance contract available to dependents of employees. Any employee or
 dependent who is enrolled in Medicare is ineligible for coverage, unless
 required by federal law.  Dependents of an employee who is  enrolled  in
 Medicare  will be eligible for dependent coverage provided the dependent
 is not also enrolled in Medicare.
   § 2. The section heading and subsections (m), (m-1) and (n) of section
 4327 of the insurance law, the section heading and subsections  (m)  and
 (n)  as  amended  by  section  58 of part D of chapter 56 of the laws of
 2013, and subsection (m-1) as amended by section 38 of subpart B of part
 J of chapter 57 of the laws of 2019, are amended to read as follows:
   Stop loss funds for standardized health insurance contracts issued  to
 qualifying small employers, QUALIFYING SMALL DENTAL EMPLOYERS and quali-
 fying individuals.
   (m)  If at any point during a suspension of enrollment of new qualify-
 ing small employers AND QUALIFYING SMALL DENTAL  EMPLOYERS,  the  super-
 intendent  determines that funds are sufficient to provide for the addi-
 tion of new enrollments,  the  superintendent  shall  be  authorized  to
 reactivate  new  enrollments and to notify all health maintenance organ-
 izations, corporations or insurers that enrollment of new employers  may
 again commence.
   (m-1)  In the event that the superintendent suspends the enrollment of
 new individuals for qualifying group  health  insurance  contracts,  the
 superintendent shall ensure that small employers, INCLUDING SMALL DENTAL
 EMPLOYERS,  seeking  to  enroll  in  a  qualified group health insurance
 contract pursuant to section  forty-three  hundred  twenty-six  of  this
 article  are  provided  information  on and directed to coverage options
 available through the health benefit exchange established by this state.
   (n) The suspension of issuance of qualifying  group  health  insurance
 contracts  to new qualifying small employers AND QUALIFYING SMALL DENTAL
 EMPLOYERS shall not preclude the addition of new employees of an employ-
 er already covered under such a contract or new dependents of  employees
 already covered under such contracts.
   §  3. This act shall take effect one year after it shall have become a
 law and shall expire and be deemed repealed 5  years  after  such  date.
 Effective immediately, the addition, amendment and/or repeal of any rule
 or regulation necessary for the implementation of this act on its effec-
 tive  date  are  authorized  to  be made and completed on or before such
 effective date.