STATE OF NEW YORK ________________________________________________________________________ 4696 2025-2026 Regular Sessions IN ASSEMBLY February 4, 2025 ___________ Introduced by M. of A. HUNTER -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to the offering of reward or incentive programs to eligible members The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subsection (c) of section 4224 of the insurance law, as 2 amended by chapter 496 of the laws of 2013, is amended and two new 3 subsections (g) and (h) are added to read as follows: 4 (c) Except as permitted by section three thousand two hundred thirty- 5 nine of this chapter or [subsection] subsections (f), (g) and (h) of 6 this section, no such life insurance company and no such savings and 7 insurance bank and no officer, agent, solicitor or representative there- 8 of and no such insurer doing in this state the business of accident and 9 health insurance and no officer, agent, solicitor or representative 10 thereof, and no licensed insurance broker and no employee or other 11 representative of any such insurer, agent or broker, shall pay, allow or 12 give, or offer to pay, allow or give, directly or indirectly, as an 13 inducement to any person to insure, or shall give, sell or purchase, or 14 offer to give, sell or purchase, as such inducement, or interdependent 15 with any policy of life insurance or annuity contract or policy of acci- 16 dent and health insurance, any stocks, bonds, or other securities, or 17 any dividends or profits accruing or to accrue thereon, or any valuable 18 consideration or inducement whatever not specified in such policy or 19 contract other than any valuable consideration, including but not limit- 20 ed to merchandise or periodical subscriptions, not exceeding twenty-five 21 dollars in value; nor shall any person in this state knowingly receive 22 as such inducement, any rebate of premium or policy fee or any special 23 favor or advantage in the dividends or other benefits to accrue on any 24 such policy or contract, or knowingly receive any paid employment or EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05810-01-5
A. 4696 2 1 contract for services of any kind, or any valuable consideration or 2 inducement whatever which is not specified in such policy or contract. 3 (g) (1) Notwithstanding subsection (c) of this section, an insurer 4 licensed to write accident and health insurance in this state or a 5 corporation organized pursuant to article forty-three of this chapter or 6 a health maintenance organization certified pursuant to article forty- 7 four of the public health law may offer an incentive or reward program 8 to support wellness, primary and preventative care, population health, 9 care coordination, case management, disease management, mental health 10 and substance use disorder treatment initiatives, evidenced-based treat- 11 ment, or quality and cost containment initiatives. With the exception 12 of incentives or rewards related to wellness programs governed by 13 section three thousand two hundred thirty-nine of this chapter, the 14 total value of such incentives may not exceed an aggregate average value 15 to the insured of six hundred dollars per year. 16 (2) Wellness programs offered pursuant to section three thousand two 17 hundred thirty-nine of this chapter and incentive or reward programs 18 offered pursuant to this subsection may (i) target populations deter- 19 mined based on age, sex, or health status; (ii) be offered for a limited 20 period or duration that does not align with the policy or contract term 21 and may include a sweepstakes, raffle or contest; and (iii) offer 22 rewards or incentives that do not involve a tangible benefit to be 23 available to all enrollees or a direct benefit to the enrollee. 24 (h)(1) This subsection shall apply only with respect to a group acci- 25 dent and health insurance policy issued by an insurer licensed to write 26 accident and health insurance in this state or a group contract issued 27 by a corporation organized pursuant to article forty-three of this chap- 28 ter, excluding community-rated policies or contracts subject to the 29 requirements of section three thousand two hundred thirty-one or four 30 thousand three hundred seventeen of this chapter. 31 (2) Notwithstanding subsection (c) of this section, no insurer 32 licensed to write accident and health insurance in this state or a 33 corporation organized pursuant to article forty-three of this chapter, 34 or officer, agent, solicitor or representative thereof shall be consid- 35 ered to be offering an impermissible inducement or rebate if it adjusts 36 its premiums to reflect payment of a commission within a range of 37 commission options filed with the superintendent in its premium rate or 38 rate manual. Nor shall a producer or any other person be considered to 39 be in violation of this section for accepting or paying a premium rate 40 that reflects a commission within a permissible range set forth in the 41 premium rate or rate manual filed with the superintendent. 42 (3) An insurer or corporation may include a range of commission 43 options in the premium rate or rate manual filed with the superintendent 44 to permit adjustment of premiums to reflect the cost of commissions 45 within the filed ranges. Within the filed range, the applicable commis- 46 sion may reflect an amount agreed upon by and between a policy holder or 47 contract holder and the insurer or corporation or producer engaged in 48 the sale. The applicable commission may vary by group and a single-case 49 filing may be submitted to the superintendent if needed to obtain 50 approval of a distinct commission arrangement. The requirements set 51 forth in section two thousand one hundred nineteen of this chapter shall 52 not apply where the premium and commission is collected by the insurer 53 or corporation and consistent with amounts set forth in the premium rate 54 or rate manual approved by the superintendent. 55 (4) If a range of commission options is included in the premium rate 56 or rate manual filed with the superintendent for a policy or contract
A. 4696 3 1 that is subject to guaranteed issuance requirements set forth in 2 subsection (t) of section three thousand two hundred twenty-one and 3 subsection (n) of section four thousand three hundred five of this chap- 4 ter, then the full range of commission options included in the premium 5 rate or rate manual filed with the superintendent must be made available 6 to all similarly situated groups seeking to purchase the coverage. 7 § 2. This act shall take effect immediately.