|
See Summary
S T A T E O F N E W Y O R K
________________________________________________________________________
6263
2009-2010 Regular Sessions
I N S E N A T E
November 4, 2009
___________
Introduced by Sens. SCHNEIDERMAN, BRESLIN -- 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 providing enhanced
consumer protections in the event of an insurer's discontinuance of
coverage
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Short title. This act shall be known and may be cited as
2 "Ian's law".
3 S 2. Paragraph 3 of subsection (p) of section 3221 of the insurance
4 law, as added by chapter 661 of the laws of 1997, is amended to read as
5 follows:
6 (3)(A) In any case in which an insurer decides to discontinue offering
7 a particular class of group or blanket policy of hospital, surgical or
8 medical expense insurance offered in the small or large group market,
9 the policy of such class may be discontinued by the insurer in accord-
10 ance with this chapter in such market only if:
11 (i) the insurer REQUESTS THAT THE SUPERINTENDENT APPROVE SUCH DISCON-
12 TINUANCE, IN SUCH FORM AS DESIGNATED BY THE SUPERINTENDENT, AND RECEIVES
13 SUCH APPROVAL; PROVIDED THAT:
14 (I) THE SUPERINTENDENT SHALL, NO SOONER THAN SIXTY DAYS AFTER RECEIPT
15 OF SUCH REQUEST, GRANT SUCH APPROVAL ONLY IF HE OR SHE DETERMINES THAT
16 THE DISCONTINUANCE OF THE COVERAGE OF THIS CLASS IN SUCH MARKET BY THE
17 INSURER IS NEITHER WITH THE INTENT NOR AS A PRETEXT TO DISCONTINUING THE
18 COVERAGE OF ANY POLICYHOLDER OR ANY INSURED DUE TO THE CLAIMS EXPERIENCE
19 OR ANY HEALTH STATUS-RELATED FACTOR RELATING TO ANY POLICYHOLDER OR
20 INSURED COVERED BY ANY SUCH POLICY; AND
21 (II) THE SUPERINTENDENT SHALL MAKE SUCH DETERMINATION ONLY AFTER EXAM-
22 INING AND TAKING INTO CONSIDERATION THE CLAIM HISTORIES AND PREMIUM
23 RATES FOR EACH POLICY IN THE CLASS, THE HISTORICAL PROFITS AND LOSSES
24 FOR THE CLASS OF POLICIES, COMMENTS FROM POLICYHOLDERS OR OTHERS SUBMIT-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD14951-04-9
S. 6263 2
1 TED TO THE SUPERINTENDENT WITHIN THIRTY DAYS AFTER RECEIPT OF ANY SUCH
2 REQUEST, AND ANY OTHER INFORMATION OR ANALYSIS THE SUPERINTENDENT
3 DEMANDS OR DEEMS RELEVANT;
4 (II) THE INSURER, NO LATER THAN THE DATE ANY SUCH REQUEST TO THE
5 SUPERINTENDENT IS MADE, PROVIDES WRITTEN NOTICE TO EACH POLICYHOLDER
6 PROVIDED COVERAGE OF THIS CLASS IN SUCH MARKET (AND TO ALL PARTICIPANTS
7 AND BENEFICIARIES COVERED UNDER SUCH COVERAGE) OF SUCH REQUEST, ALONG
8 WITH NOTICE OF THE EARLIEST POSSIBLE DATE THAT THE SUPERINTENDENT MIGHT
9 APPROVE SUCH REQUEST, THE EARLIEST POSSIBLE DATE THAT SUCH COVERAGE
10 COULD BE DISCONTINUED, AND A STATEMENT WRITTEN IN PLAIN ENGLISH OF THE
11 OBLIGATIONS OF THE INSURER AND THE RIGHTS OF POLICYHOLDERS PURSUANT TO
12 THIS SUBPARAGRAPH AND SUBPARAGRAPHS (A-1) AND (D) OF THIS PARAGRAPH;
13 (III) THE INSURER, UPON APPROVAL BY THE SUPERINTENDENT OF ANY SUCH
14 REQUEST:
15 (I) provides written notice to each policyholder provided coverage of
16 this class in such market (and to all participants and beneficiaries
17 covered under such coverage) of such discontinuance at least ninety days
18 prior to the date of discontinuance of such coverage;
19 [(ii) the insurer] (II) offers to each policyholder provided coverage
20 of this class in such market, the option to purchase all (or, in the
21 case of the large group market, any) other hospital, surgical and
22 medical expense coverage currently being offered by the insurer to a
23 group in such market; and
24 [(iii)] (III) in exercising the option to discontinue coverage of this
25 class and in offering the option of coverage under [item (ii)] SUBITEM
26 (II) of this [subparagraph] ITEM, the insurer acts uniformly without
27 regard to the claims experience of those policyholders or any health
28 status-related factor relating to any insureds covered or new insureds
29 who may become eligible for such coverage.
30 (A-1) WHERE AN INSURER DISCONTINUES A PARTICULAR CLASS OF GROUP OR
31 BLANKET POLICY OF HOSPITAL, SURGICAL OR MEDICAL EXPENSE INSURANCE
32 OFFERED IN THE SMALL OR LARGE GROUP MARKET, OTHER THAN WHERE THE SUPER-
33 INTENDENT AUTHORIZES SUCH DISCONTINUANCE PURSUANT TO SUBPARAGRAPH (A) OF
34 THIS PARAGRAPH, SUCH INSURER SHALL BE LIABLE TO THE FORMER HOLDER OR
35 BENEFICIARY OF SUCH POLICY, OR TO HIS OR HER ESTATE, FOR COMPENSATORY
36 DAMAGES ARISING FROM SUCH UNLAWFUL DISCONTINUANCE, PLUS COSTS AND
37 REASONABLE ATTORNEYS' FEES, IN AN ACTION COMMENCED NO LATER THAN THREE
38 YEARS AFTER THE DATE OF SUCH DISCONTINUANCE. IN ANY SUCH ACTION, THE
39 COURT MAY GRANT SUCH INJUNCTIVE RELIEF AS THE COURT MAY DEEM PROPER.
40 ANY DETERMINATION BY THE SUPERINTENDENT, PURSUANT TO SUBPARAGRAPH (A) OF
41 THIS PARAGRAPH, SHALL BE REVIEWABLE IN THE MANNER SPECIFIED BY ARTICLE
42 SEVENTY-EIGHT OF THE CIVIL PRACTICE LAW AND RULES.
43 (A-2) THE SUPERINTENDENT IS AUTHORIZED TO ADOPT SUCH RULES AND REGU-
44 LATIONS AS HE OR SHE MAY DEEM NECESSARY TO EFFECTUATE THE PURPOSES OF
45 SUBPARAGRAPH (A) OF THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED TO, IDEN-
46 TIFYING FACTORS THAT CREATE A PRESUMPTION THAT THE DISCONTINUANCE OF THE
47 COVERAGE OF ANY CLASS IS WITH THE INTENT OR AS A PRETEXT TO DISCONTINU-
48 ING THE COVERAGE OF ANY POLICYHOLDER OR ANY INSURED DUE TO THE CLAIMS
49 EXPERIENCE OR ANY HEALTH STATUS-RELATED FACTOR RELATING TO ANY POLICY-
50 HOLDER OR INSURED COVERED BY ANY SUCH POLICY.
51 (B) In any case in which an insurer elects to discontinue offering all
52 hospital, surgical and medical expense coverage in the small group
53 market or the large group market, or both markets, in this state, health
54 insurance coverage may be discontinued by the insurer only if:
55 (i) the insurer provides written notice to the superintendent and to
56 each policyholder (and participants and beneficiaries covered under such
S. 6263 3
1 coverage) of such discontinuance at least one hundred eighty days prior
2 to the date of the discontinuance of such coverage;
3 (ii) all hospital, surgical and medical expense coverage issued or
4 delivered for issuance in this state in such market (or markets) is
5 discontinued and coverage under such policies in such market (or
6 markets) is not renewed; and
7 (iii) in addition to the notice to the superintendent referred to in
8 item (i) of this subparagraph, the insurer must provide the superinten-
9 dent with a written plan to minimize potential disruption in the market-
10 place occasioned by its withdrawal from the market.
11 (C) In the case of a discontinuance under subparagraph (B) of this
12 paragraph in a market, the insurer may not provide for the issuance of
13 any group or blanket policy of hospital, surgical or medical expense
14 insurance in that market in this state during the five year period
15 beginning on the date of the discontinuance of the last health insurance
16 policy not so renewed.
17 (D) THE SUPERINTENDENT SHALL, WHERE MAJOR MEDICAL INSURANCE OR INSUR-
18 ANCE PROVIDING MAJOR MEDICAL TYPE BENEFITS IS DISCONTINUED PURSUANT TO
19 SUBPARAGRAPH (A) OR (B) OF THIS PARAGRAPH, ORDER THAT AN EXTENDED BENE-
20 FIT SHALL BE PROVIDED DURING TOTAL DISABILITY, WITH RESPECT TO THE SICK-
21 NESS, INJURY OR PREGNANCY WHICH CAUSED THE DISABILITY, OF AT LEAST EIGH-
22 TEEN MONTHS SUBSEQUENT TO DISCONTINUANCE OF INSURANCE UNLESS SIMILAR
23 COVERAGE IS AFFORDED FOR THE TOTAL DISABILITY UNDER ANOTHER GROUP PLAN.
24 S 3. Paragraph 3 of subsection (j) of section 4305 of the insurance
25 law, as added by chapter 661 of the laws of 1997, is amended to read as
26 follows:
27 (3)(A) In any case in which a corporation decides to discontinue
28 offering a particular class of group or blanket contract of hospital,
29 surgical or medical expense insurance offered in the small or large
30 group market, the contract of such class may be discontinued by the
31 corporation in accordance with this chapter in such market only if:
32 (i) the corporation REQUESTS THAT THE SUPERINTENDENT APPROVE SUCH
33 DISCONTINUANCE, IN SUCH FORM AS DESIGNATED BY THE SUPERINTENDENT, AND
34 RECEIVES SUCH APPROVAL; PROVIDED THAT:
35 (I) THE SUPERINTENDENT SHALL, NO SOONER THAN SIXTY DAYS AFTER RECEIPT
36 OF SUCH REQUEST, GRANT SUCH APPROVAL ONLY IF HE OR SHE DETERMINES THAT
37 THE DISCONTINUANCE OF THE COVERAGE OF THIS CLASS IN SUCH MARKET BY THE
38 INSURER IS NEITHER WITH THE INTENT NOR AS A PRETEXT TO, DISCONTINUING
39 THE COVERAGE OF ANY CONTACT HOLDER OR ANY SUBSCRIBER DUE TO THE CLAIMS
40 EXPERIENCE OR ANY HEALTH STATUS-RELATED FACTOR RELATING TO ANY CONTRACT
41 HOLDER OR SUBSCRIBER COVERED BY ANY SUCH CONTRACT; AND
42 (II) THE SUPERINTENDENT SHALL MAKE SUCH DETERMINATION ONLY AFTER EXAM-
43 INING AND TAKING INTO CONSIDERATION THE CLAIM HISTORIES AND PREMIUM
44 RATES FOR EACH CONTRACT IN THE CLASS, THE HISTORICAL PROFITS AND LOSSES
45 FOR THE CLASS OF CONTRACTS, COMMENTS FROM CONTRACT HOLDERS OR OTHERS
46 SUBMITTED TO THE SUPERINTENDENT WITHIN THIRTY DAYS AFTER RECEIPT OF ANY
47 SUCH REQUEST, AND ANY OTHER INFORMATION OR ANALYSIS THE SUPERINTENDENT
48 DEMANDS OR DEEMS RELEVANT;
49 (II) THE CORPORATION, NO LATER THAN THE DATE ANY SUCH REQUEST TO THE
50 SUPERINTENDENT IS MADE, PROVIDES WRITTEN NOTICE TO EACH CONTRACT HOLDER
51 PROVIDED COVERAGE OF THIS CLASS IN SUCH MARKET (AND TO ALL PARTICIPANTS
52 AND BENEFICIARIES COVERED UNDER SUCH COVERAGE) OF SUCH REQUEST, ALONG
53 WITH NOTICE OF THE EARLIEST POSSIBLE DATE THAT THE SUPERINTENDENT MIGHT
54 APPROVE SUCH REQUEST, AND THE EARLIEST POSSIBLE DATE THAT SUCH COVERAGE
55 COULD BE DISCONTINUED, AND A STATEMENT WRITTEN IN PLAIN ENGLISH OF THE
56 OBLIGATIONS OF THE CORPORATION AND THE RIGHTS OF CONTRACT HOLDERS PURSU-
S. 6263 4
1 ANT TO THIS SUBPARAGRAPH AND SUBPARAGRAPHS (A-1) AND (D) OF THIS PARA-
2 GRAPH;
3 (III) THE CORPORATION, UPON APPROVAL BY THE SUPERINTENDENT OF ANY SUCH
4 REQUEST:
5 (I) provides written notice to each contract holder provided coverage
6 of this class in such market (and to all participants and beneficiaries
7 covered under such coverage) of such discontinuance at least ninety days
8 prior to the date of discontinuance of such coverage;
9 [(ii) the corporation] (II) offers to each contract holder provided
10 coverage of this class in such market, the option to purchase all (or,
11 in the case of the large group market, any) other hospital, surgical and
12 medical expense coverage currently being offered by the corporation to a
13 group in such market; and
14 [(iii)] (III) in exercising the option to discontinue coverage of this
15 class and in offering the option of coverage under [item (ii)] SUBITEM
16 (II) of this [subparagraph] ITEM, the corporation acts uniformly without
17 regard to the claims experience of those contract holders or any health
18 status-related factor relating to any subscribers covered or new
19 subscribers who may become eligible for such coverage.
20 (A-1) WHERE A CORPORATION DISCONTINUES A PARTICULAR CLASS OF GROUP OR
21 BLANKET CONTRACT OF HOSPITAL, SURGICAL OR MEDICAL EXPENSE INSURANCE
22 OFFERED IN THE SMALL OR LARGE GROUP MARKET, OTHER THAN WHERE THE SUPER-
23 INTENDENT AUTHORIZES SUCH DISCONTINUANCE PURSUANT TO SUBPARAGRAPH (A) OF
24 THIS PARAGRAPH, SUCH CORPORATION SHALL BE LIABLE TO THE FORMER HOLDER OR
25 BENEFICIARY OF SUCH CONTRACT, OR TO HIS OR HER ESTATE, FOR COMPENSATORY
26 DAMAGES ARISING FROM SUCH UNLAWFUL DISCONTINUANCE, PLUS COSTS AND
27 REASONABLE ATTORNEYS' FEES, IN AN ACTION COMMENCED NO LATER THAN THREE
28 YEARS AFTER THE DATE OF SUCH DISCONTINUANCE. IN ANY SUCH ACTION, THE
29 COURT MAY GRANT SUCH INJUNCTIVE RELIEF AS THE COURT MAY DEEM PROPER. ANY
30 DETERMINATION BY THE SUPERINTENDENT, PURSUANT TO SUBPARAGRAPH (A) OF
31 THIS PARAGRAPH, SHALL BE REVIEWABLE IN THE MANNER SPECIFIED BY ARTICLE
32 SEVENTY-EIGHT OF THE CIVIL PRACTICE LAW AND RULES.
33 (A-2) THE SUPERINTENDENT IS AUTHORIZED TO ADOPT SUCH RULES AND REGU-
34 LATIONS AS IS NECESSARY TO EFFECTUATE THE PURPOSES OF SUBPARAGRAPH (A)
35 OF THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED TO, IDENTIFYING FACTORS
36 THAT CREATE A PRESUMPTION THAT THE DISCONTINUANCE OF THE COVERAGE OF ANY
37 CLASS IS WITH THE INTENT OR AS A PRETEXT TO DISCONTINUING THE COVERAGE
38 OF ANY CONTRACT HOLDER OR ANY SUBSCRIBER DUE TO THE CLAIMS EXPERIENCE OR
39 ANY HEALTH STATUS-RELATED FACTOR RELATING TO ANY CONTRACT HOLDER OR
40 SUBSCRIBER COVERED BY ANY SUCH CONTRACT.
41 (B) In any case in which a corporation elects to discontinue offering
42 all hospital, surgical and medical expense coverage in the small group
43 market or the large group market, or both markets, in this state, health
44 insurance coverage may be discontinued by the corporation only if:
45 (i) the corporation provides written notice to the superintendent and
46 to each contract holder (and participants and beneficiaries covered
47 under such coverage) of such discontinuance at least one hundred eighty
48 days prior to the date of the discontinuance of such coverage;
49 (ii) all hospital, surgical and medical expense coverage issued or
50 delivered for issuance in this state in such market or markets is
51 discontinued and coverage under such contracts in such market or markets
52 is not renewed; and
53 (iii) in addition to the notice to the superintendent referred to in
54 item (i) of this subparagraph, the corporation must provide the super-
55 intendent with a written plan to minimize potential disruption in the
56 marketplace occasioned by its withdrawal from the market.
S. 6263 5
1 (C) In the case of a discontinuance under subparagraph (B) of this
2 paragraph in a market, the corporation may not provide for the issuance
3 of any group or blanket contract of hospital, surgical or medical
4 expense insurance in that market in this state during the five-year
5 period beginning on the date of the discontinuance of the last health
6 insurance contract not so renewed.
7 (D) THE SUPERINTENDENT SHALL, WHERE MAJOR MEDICAL INSURANCE OR INSUR-
8 ANCE PROVIDING MAJOR MEDICAL TYPE BENEFITS IS DISCONTINUED PURSUANT TO
9 SUBPARAGRAPH (A) OR (B) OF THIS PARAGRAPH, ORDER THAT AN EXTENDED BENE-
10 FIT SHALL BE PROVIDED DURING TOTAL DISABILITY, WITH RESPECT TO THE SICK-
11 NESS, INJURY OR PREGNANCY WHICH CAUSED THE DISABILITY, OF AT LEAST EIGH-
12 TEEN MONTHS SUBSEQUENT TO DISCONTINUANCE OF INSURANCE UNLESS SIMILAR
13 COVERAGE IS AFFORDED FOR THE TOTAL DISABILITY UNDER ANOTHER GROUP PLAN.
14 S 4. This act shall take effect immediately.
|
