S. 4675-A(Hannon)/A. 10884--A(Morelle)
Summary: The bill adds a new Section 3239 to the Insurance Law to permit insurers,
Article 43 corporations, HMOs, and municipal cooperative health benefits plans to offer wellness
programs designed to promote health and prevent disease. Specifics include:
- The bill defines a “wellness program” as “a program designed to promote health
and prevent disease that may contain rewards and incentives for participation.” Wellness programs
may include, but are not limited to, the use of a health risk assessment tool, smoking cessation
programs, weight management programs, a stress management programs, worker injury prevention
programs, nutrition education programs, and health or fitness incentive programs. The terms
of the wellness program must be set forth in the policy or contract.
- The bill specifies the permissible rewards that may be provided under a wellness
program. These rewards include full or partial reimbursement of the cost of participating in
a smoking cessation or weight management program, full or partial reimbursement of the cost of
membership in a health club or fitness center, the waiver or reduction of copayments, coinsurance,
and deductibles for preventive services covered under the policy, and monetary rewards in the
form of gift cards or gift certificates, as long as the recipient is encouraged to use the reward
for a product or a service that promotes good health.
- The bill provides that group policies and contracts may contain rewards or incentives
that involve a discounted premium rates, or rebates or refunds of premium, provided that the
discounted premium rate, or the rebate or refund of premium, is based on an actuarial demonstration
that the wellness program can reasonably be expected to result in the overall good health and
well-being of the group. However, the bill prohibits a discounted premium rate, or rebate or
refund of premium, for community-rated plans.
- The bill permits accident and health insurers, Article 43 corporations, HMOs,
and municipal cooperative health benefits plans to base rewards on group members meeting specific
standards based on a health condition. In those cases, the wellness program must meet the requirements
of 45 C.F.R. Part 146.
The bill also amends Insurance Law § 4224(c) by adding the phrase “except as permitted
by section three thousand two-hundred thirty-nine of this chapter” to the beginning of the subsection,
which provides, among other things, that no insurer, broker or other stated entity shall give any
person an inducement not specified in any policy or contract, nor shall any person knowingly receive
as such inducement, any rebate of premium, or policy fee.
Effective Date: Immediately.
Last Action: The bill was signed by the Governor on September 25, 2008 (Chapter 627).