N.Y. ISC Law § 3239 — New York Code / Act ISC / Article 32 / Section 3239
Wellness programs
Status: in_force

§ 3239. Wellness programs. (a) An insurer licensed to write life\ninsurance may establish a wellness program in conjunction with its\nissuance of life insurance policies and an insurer licensed to write\naccident and health insurance, a corporation organized pursuant to\narticle forty-three of this chapter, a health maintenance organization\ncertified pursuant to article forty-four of the public health law and a\nmunicipal cooperative health benefits plan may establish a wellness\nprogram in conjunction with its issuance of a group accident and health\ninsurance policy or group subscriber contract. A "wellness program" is a\nprogram designed to promote health, longevity or prevent disease that\nmay contain rewards and incentives for participation. A "wellness\nprogram" shall not include limited benefits health insurance.\nParticipation in the wellness program shall be available to\nsimilarly-situated members of the group or with regard to life\ninsurance, to all insureds within the same class and equal expectation\nof life and shall be voluntary on the part of the member or insured.\nWith regard to life insurance, an insurer is prohibited from increasing\npremiums or charges stated in the policy as a result of participation or\nnon-participation in the program. The terms of the wellness program\nshall be set forth in the policy or contract. With regard to a wellness\nprogram established in connection with life insurance, an insurer shall\nprovide a prominent disclosure to an applicant at or prior to the time\nof application that the program is not health insurance and participants\nshould not view the program as a substitute for the purchase of health\ninsurance.\n  (b) A wellness program may include, but is not limited to, the\nfollowing programs or services:\n  (1) the use of a health risk assessment tool;\n  (2) a smoking cessation program;\n  (3) a weight management program;\n  (4) a stress and/or hypertension management program;\n  (5) a worker injury prevention program;\n  (6) a nutrition education program;\n  (7) health or fitness incentive programs;\n  (8) a coordinated weight management, nutrition, stress management and\nphysical fitness program to combat the high incidence of adult and\nchildhood obesity, asthma and other chronic respiratory conditions;\n  (9) a substance or alcohol abuse cessation program;\n  (10) a program to manage and cope with chronic pain;\n  (11) a preventive care program, screenings (including biometric\nscreenings), or chronic disease management program; and\n  (12) a stress management program, including participation in a\nmeditation or sleep improvement program.\n  (c)(1) A wellness program may use rewards and incentives for\nparticipation provided that where the group health insurance policy or\nsubscriber contract is required to be community-rated, the rewards and\nincentives shall not include a discounted premium rate or a rebate or\nrefund of premium.\n  (2) Permissible rewards and incentives may include:\n  (A) full or partial reimbursement of the cost of participating in\nsmoking cessation, weight management, stress and/or hypertension, worker\ninjury prevention, nutrition education, substance or alcohol abuse\ncessation, preventive care programs, screenings, chronic disease\nmanagement programs, or chronic pain management and coping programs;\n  (B) full or partial reimbursement of the cost of membership in a\nhealth club or fitness center;\n  (C) (1) the waiver or reduction of copayments, coinsurance and\ndeductibles for preventive services covered under the group health\ninsurance policy or subscriber contract;\n  (2) a premium refund, discount, or policy value credit, or other\nincrease in benefits or decrease in charges under a life insurance\npolicy;\n  (D) monetary rewards in the form of gift cards, gift certificates,\nvouchers or discounts on products or services in return for engaging in\nhealthy behaviors;\n  (E) full or partial reimbursement of the cost of participating in a\nstress management program or activity, including participation in a\nmeditation or sleep improvement program, provided that such program or\nactivity shall be based on data and research that the program or service\ncan be reasonably expected to result in overall good health, well being,\nor improved mortality risk;\n  (F) full or partial reimbursement of the cost of participating in a\nhealth or fitness program; and\n  (G) full or partial reimbursement of the cost of a wearable device and\nany associated subscription membership to track physical activity or\nbiometric data, and which incents behavioral changes to improve health\nor mortality risk.\n  (3) Where the reward involves a group member's meeting a specified\nstandard based on a health condition, the wellness program under a\nhealth insurance policy shall meet the requirements of 45 CFR Part 146.\n  (4) A reward or incentive that involves a discounted premium rate or a\nrebate or refund of premium under accident and health insurance policies\nshall be based on actuarial demonstration that the wellness program can\nreasonably be expected to result in the overall good health and well\nbeing of the group. A premium refund, discount, or policy value credit,\nor other increase in benefits or decrease in charges under life\ninsurance policies in connection with a wellness program shall be based\non sound actuarial principles related to actual or reasonably\nanticipated experience.\n  (d) Fair collection and use of personal information. (1) Nonpublic\npersonal information, including health data, an insurer collects and\nshares in connection with a wellness program shall be subject to all\nstate and federal privacy and security laws and regulations promulgated\nthereunder, including 11 NYCRR 420.\n  (2) Wellness program participants shall have the right to obtain a\ncopy of their wellness program information and an opportunity to correct\nany inaccuracies.\n  (3) An insurer may contract with a third party for purposes of\nadministering or operating a wellness program on such insurer's behalf\nprovided that the insurer maintains a system of supervision to ensure\ncompliance with this section, including procedures to take appropriate\ncorrective action for any participant harmed by a violation of this\nsection by the insurer directly or by any third party with whom the\ninsurer contracts.\n