STATE OF NEW YORK ________________________________________________________________________ 8019 IN SENATE January 5, 2024 ___________ Introduced by Sen. 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 wellness programs; and to amend a chapter of the laws of 2023 amending the insurance law relating to authorizing life insurers to establish wellness programs, as proposed in legislative bills numbers S. 5890-A and A. 2853-B, in relation to the effectiveness thereof The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 3239 of the insurance law, as amended by a chapter 2 of the laws of 2023 amending the insurance law relating to authorizing 3 life insurers to establish wellness programs, as proposed in legislative 4 bills numbers S. 5890-A and A. 2853-B, is amended to read as follows: 5 § 3239. Wellness programs. (a) An insurer licensed to write life 6 insurance may establish a wellness program in conjunction with its issu- 7 ance of life insurance policies and an insurer licensed to write acci- 8 dent and health insurance, a corporation organized pursuant to article 9 forty-three of this chapter, a health maintenance organization certified 10 pursuant to article forty-four of the public health law and a municipal 11 cooperative health benefits plan may establish a wellness program in 12 conjunction with its issuance of a group accident and health insurance 13 policy or group subscriber contract. A "wellness program" is a program 14 designed to promote health, longevity or prevent disease that may 15 contain rewards and incentives for participation. A "wellness program" 16 shall not include limited benefits health insurance. Participation in 17 the wellness program shall be available to similarly-situated members of 18 the group or with regard to life insurance, to all insureds within the 19 same class [in a manner that is not unfairly discriminatory] and equal 20 expectation of life and shall be voluntary on the part of the member or 21 insured. With regard to life insurance, an insurer is prohibited from 22 increasing premiums or charges stated in the policy as a result of 23 participation or non-participation in the program. The terms of the 24 wellness program shall be set forth in the policy or contract. With 25 regard to a wellness program established in connection with life insur- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07895-06-4
S. 8019 2 1 ance, an insurer shall provide a prominent disclosure to an applicant at 2 or prior to the time of application that the program is not health 3 insurance and participants should not view the program as a substitute 4 for the purchase of health insurance. 5 (b) A wellness program may include, but is not limited to, the follow- 6 ing programs or services: 7 (1) the use of a health risk assessment tool; 8 (2) a smoking cessation program; 9 (3) a weight management program; 10 (4) a stress and/or hypertension management program; 11 (5) a worker injury prevention program; 12 (6) a nutrition education program; 13 (7) health or fitness incentive programs; 14 (8) a coordinated weight management, nutrition, stress management and 15 physical fitness program to combat the high incidence of adult and 16 childhood obesity, asthma and other chronic respiratory conditions; 17 (9) a substance or alcohol abuse cessation program; 18 (10) a program to manage and cope with chronic pain; 19 (11) a [preventative] preventive care program, screenings (including 20 biometric screenings), or chronic disease management program; and 21 (12) a stress management program, including participation in a medi- 22 tation[,] or sleep improvement [or similar] program [or service]. 23 (c)(1) A wellness program may use rewards and incentives for partic- 24 ipation provided that where the group health insurance policy or 25 subscriber contract is required to be community-rated, the rewards and 26 incentives shall not include a discounted premium rate or a rebate or 27 refund of premium. 28 (2) Permissible rewards and incentives may include: 29 (A) full or partial reimbursement of the cost of participating in 30 smoking cessation, weight management, stress and/or hypertension, worker 31 injury prevention, nutrition education, substance or alcohol abuse 32 cessation, [preventative] preventive care programs, [or] screenings, 33 chronic disease management programs, or chronic pain management and 34 coping programs; 35 (B) full or partial reimbursement of the cost of membership in a 36 health club or fitness center; 37 (C) (1) the waiver or reduction of copayments, coinsurance and deduct- 38 ibles for preventive services covered under the group health insurance 39 policy or subscriber contract; 40 (2) a premium refund, discount, or policy value credit, or other 41 increase in benefits or decrease in charges under a life insurance poli- 42 cy; 43 (D) monetary rewards in the form of gift cards, gift certificates, 44 vouchers or discounts on products or services [that are intended to 45 incent behavioral changes that improve the health or reduce the risk of 46 death of the insured] in return for engaging in healthy behaviors; 47 (E) full or partial reimbursement of the cost of participating in a 48 stress management program or activity, including participation in a 49 meditation[,] or sleep improvement [or similar] program [or service], 50 provided that such program or activity shall be based on data and 51 research that the program or service can be reasonably expected to 52 result in overall good health, well being, or improved mortality risk; 53 (F) full or partial reimbursement of the cost of participating in a 54 health or fitness program; and 55 (G) full or partial reimbursement of the cost of a wearable device and 56 any associated subscription membership [that can be used] to track phys-
S. 8019 3 1 ical activity or biometric data, and which incents behavioral changes to 2 improve [the] health or [reduce the risk of death of the insured; and 3 (H) full or partial reimbursement of biometric screenings] mortality 4 risk. 5 (3) Where the reward involves a group member's meeting a specified 6 standard based on a health condition, the wellness program under a 7 health insurance policy [must] shall meet the requirements of 45 CFR 8 Part 146. 9 (4) A reward or incentive [which] that involves a discounted premium 10 rate or a rebate or refund of premium under [a] accident and health 11 insurance [policy] policies shall be based on actuarial demonstration 12 that the wellness program can reasonably be expected to result in the 13 overall good health and well being of the group. A [reward or incentive 14 that involves a discounted premium rate or rebate or refund of] premium 15 refund, discount, or policy value credit, or other increase in benefits 16 or decrease in charges under [a] life insurance [policy shall be actuar- 17 ially supported by data and research that such incentives or rewards, in 18 the aggregate, are directed to sharing the benefit of improving expected 19 mortality risk] policies in connection with a wellness program shall be 20 based on sound actuarial principles related to actual or reasonably 21 anticipated experience. [Data collected] 22 (d) Fair collection and use of personal information. (1) Nonpublic 23 personal information, including health data, an insurer collects and 24 shares in connection with a wellness program shall be subject to all 25 state and federal privacy and security laws and regulations promulgated 26 thereunder, including 11 NYCRR 420. 27 (2) Wellness program participants shall have the right to obtain a 28 copy of their wellness program information and an opportunity to correct 29 any inaccuracies. 30 (3) An insurer may contract with a third party for purposes of admin- 31 istering or operating a wellness program on such insurer's behalf 32 provided that the insurer maintains a system of supervision to ensure 33 compliance with this section, including procedures to take appropriate 34 corrective action for any participant harmed by a violation of this 35 section by the insurer directly or by any third party with whom the 36 insurer contracts. 37 § 2. Section 2 of a chapter of the laws of 2023 amending the insurance 38 law relating to authorizing life insurers to establish wellness 39 programs, as proposed in legislative bills numbers S. 5890-A and A. 40 2853-B, is amended to read as follows: 41 § 2. This act shall take effect immediately and shall apply to poli- 42 cies issued, renewed, modified, or amended on or after such effective 43 date. 44 § 3. This act shall take effect immediately; provided, however, that 45 section one of this act shall take effect on the same date and in the 46 same manner as a chapter of the laws of 2023 amending the insurance law 47 relating to authorizing life insurers to establish wellness programs, 48 as proposed in legislative bills numbers S. 5890-A and A. 2853-B, takes 49 effect.