Life Bureau Filing Guidance Note

Filing Guidance for Submitting Wellness Programs in Connection with Life Insurance

Guidance Date: 07/16/2024

Chapter 768 of the Laws of 2023 and Chapter 3 of the Laws of 2024 revised Insurance Law § 3239 to provide that Insurers licensed to write life insurance may establish a wellness program in conjunction with the issuance of life insurance policies.  The Life Bureau provides the following guidance to assist insurers submitting wellness programs to the Life Bureau for use with life insurance.

I. Voluntary and Non-discriminatory. 

Participation in the wellness program must be voluntary on the part of the insured and must be available to all insureds within the same class and equal expectation of life.  An insurer is prohibited from increasing premiums or charges stated in the policy as a result of participation or non-participation in the program.  See § 3239(a).

II. Wellness Program Defined.

      A. Wellness Program is defined in § 3239(a) as a program designed to promote health, longevity or prevent disease and may contain rewards and incentives for participation.  Section 3239(a) further provides that a wellness program shall not include limited benefits health insurance. 

      B. Programs and services in a wellness program may include, but are not limited to, the following:

(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;

       (10) a program to manage and cope with chronic pain;

(11) a preventive care program, screenings (including biometric screenings), or chronic disease management program; and

(12) a stress management program, including participation in a meditation or sleep improvement program.

      C. Rewards and incentives for participation in the wellness program may include:

(1) 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, preventive care programs, screenings, chronic disease management programs, or chronic pain management and coping programs;

(2) full or partial reimbursement of the cost of membership in a health club or fitness center;

(3) a premium refund, discount, or policy value credit, or other increase in benefits or decrease in charges under a life insurance policy;

(4) monetary rewards in the form of gift cards, gift certificates, vouchers or discounts on products or services in return for engaging in healthy behaviors;

(5) full or partial reimbursement of the cost of participating in a stress management program or activity, including participation in a meditation or sleep improvement program, 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, wellbeing, or improved mortality risk;

(6) full or partial reimbursement of the cost of participating in a health or fitness program; and

(7) full or partial reimbursement of the cost of a wearable device and any associated subscription membership to track physical activity or biometric data, and which incents behavioral changes to improve health or mortality risk.

III.  Preparation of Policy Forms.

Section 3239(a) provides that the terms of the wellness program shall be set forth in the policy (including certificate in the case of group life insurance).  It is acceptable to use a rider attached to the policy and certificate to set forth the terms of the wellness program.  

      A. The policy form must describe in full detail the benefits being provided including any limitations, restrictions and costs associated with the benefits and the identity of the entity providing the benefits. 

      B. The policy form may not include language disclaiming the insurer’s responsibility for benefits promised in the policy form.

      C. Any variable material related to wellness program provisions should be handled in the same manner as any other variable material for policy forms, in that the variable material must be set forth in a memorandum of variable material and each item of variable material must include a detailed explanation of how and when the item may vary. 

      D.  Pursuant to § 3239(a), the insurer must provide a prominent disclosure to an applicant at or prior to the time of application that the program is not health insurance and participants should not view the program as a substitute for the purchase of health insurance.  It is permissible to include this disclosure in the application form or in a separate disclosure document.

IV.  Submission of Policy Forms. 

      A.  The policy form containing the wellness program and the memorandum of variable material must be submitted via SERFF under the Forms tab.

      B.  The Requested Filing Mode in SERFF should be “Review & Approval”.  The certified process under Circular Letter No. 6 of 2004 may not be used unless the Department has granted prior permission.

      C.  The SERFF Filing Description should:

(1) indicate that the policy form contains a wellness program.  If a wellness rider is submitted separately from the policy, the filing description should identify, by form number, Department file number, and date of approval, the previously approved policy forms with which the rider will be used;

(2) confirm that the insurer will not use any health or wellness information collected as a result of participation or non-participation in any wellness program to increase premiums or charges stated in the policy. See § 3239(a); and

(3) confirm that the insurer will comply with the Fair Collection and Use of Personal Information provisions in § 3239(d).

      D.  Actuarial Material. If the wellness program provides for a premium refund, discount, or decrease in charges or a policy value credit or other increase in benefits, the filing must include, under the SERFF Supporting Documentation tab, actuarial material demonstrating that such adjustment is based on sound actuarial principles related to actual or reasonably anticipated experience.  See § 3239(c)(4).

Contact

Questions regarding this guidance should be sent to the Life Bureau via email.