NY Ins L § 3233 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3233 - Stabilization of Health Insurance Markets and Premium Rates.

§  3233.  Stabilization of health insurance markets and premium rates. (a) Notwithstanding any provision of this chapter or any other  chapter, on   or   before   October   first,   nineteen  hundred  ninety-two  the superintendent  shall  promulgate  regulations  to  assure  an   orderly implementation   and  ongoing  operation  of  the  open  enrollment  and community rating required by sections thirty-two hundred thirty-one  and forty-three  hundred  seventeen  of  this  chapter, including provisions designed to encourage insurers to remain in or enter the small group  or individual  health insurance markets. The regulations shall apply to all insurers and  health  maintenance  organizations  subject  to  community rating.  The  regulations  shall  be  designed  to  promote an insurance marketplace where premiums do not unduly fluctuate, insurers and  health maintenance  organizations  are  reasonably protected against unexpected significant shifts in the number of persons insured,  and  other  market stability  features  deemed  appropriate  by  the  superintendent.  Such regulations  shall  not  require  any  insurer  or  health   maintenance organization  subject  to  this section, or any subsidiary or controlled person of a holding  company  of  such  insurer  or  health  maintenance organization,  to  enter, continue to conduct, or withdraw from any line of business as a condition of entering, continuing  in,  or  withdrawing from any other line of business.  (b)  Prior  to  adopting  such  regulations  the  superintendent shall convene  a  technical  advisory  committee   to   provide   advice   and recommendations  to  the  superintendent  on  issues  including, but not limited to, voluntary reinsurance, pooling, risk sharing, the moderation of initial community rates  as  compared  to  prior  rates,  or  premium stabilization   methods.  The  technical  advisory  committee  shall  be comprised of nine members, one of whom shall be  the  superintendent  or his  or  her  designee.  The superintendent or his or her designee shall chair  the  committee  and  shall  appoint  two  other  members  to  the committee.  The temporary president of the senate and the speaker of the assembly  shall  each  appoint  three  members  to  the  committee.  The appointees  shall  be  representatives  of  commercial  health insurers, not-for-profit health insurers,  health  maintenance  organizations  and purchasers of insurance and shall be named no later than July fifteenth, nineteen  hundred ninety-two. In addition, the superintendent may obtain the services of an actuary with experience relating to premium rates and market stabilization for small group health insurance.  (c) (1) Such  regulations  shall  include  reinsurance  or  a  pooling process  involving  insurer  contributions  to, or receipts from, a fund which shall be designed to share the  risk  of  or  equalize  high  cost claims,  claims of high cost persons, cost variations among insurers and health maintenance organizations based upon demographic factors  of  the persons  insured  which  correlate with such cost variations designed to protect  insurers  from  disproportionate  adverse  risks  of   offering coverage  to all applicants; provided that such regulations shall relate only to risk sharing among insurers and health maintenance organizations and shall not create differences in community rates charged by a  single insurer  because  an  individual's  or  small  group's coverage has been reinsured or pooled, and neither the small  employer  nor  the  employee shall  have  reason  to  know  that their coverage has been reinsured or pooled pursuant to such regulations. Such regulations may  also  include other  mechanisms designed to share risks or prevent undue variations in insurer claim costs which are not related  to  expected  differences  in insurer  costs  based  upon  competition,  innovation  and efficiency of operation. The regulations may segregate  any  reinsurance,  pooling  or other process among various geographic regions of the state.  (2) Effective on and after January first, nineteen hundred ninety-six, health  maintenance  organizations  and  insurers  shall  be required to contribute only ninety percent of the  amounts  calculated  pursuant  to regulations  based  upon  demographic factors. The required contribution will be further reduced by an additional twenty-two and one-half percent on  each  succeeding January first. The aggregate total contributions by health maintenance  organizations  and  insurers  required  pursuant  to regulations  based  upon specified medical conditions shall be increased by the aggregate  total  amount  of  savings  resulting  from  decreased contributions  calculated pursuant to regulations based upon demographic factors, provided, however, that the funds received  by  an  insurer  or health  maintenance organization pursuant to such regulations be applied to reduce the premiums of  the  particular  class  of  contracts  issued pursuant  to  sections  four  thousand three hundred twenty-one and four thousand three hundred twenty-two  of  this  chapter  whose  subscribers caused the payments to be received.  (3)  On  and after January first, two thousand, such regulations shall include only reinsurance or a  pooling  process  involving  insurer  and health  maintenance  organization  contributions to, or receipts from, a fund which shall be designed to share the risk of or equalize high  cost claims   or  the  claims  of  high  cost  persons;  provided  that  such regulations shall relate only to risk sharing among insurers and  health maintenance  organizations and shall not create differences in community rates charged by a single insurer  or  health  maintenance  organization because  an individual's or small group's coverage has been reinsured or pooled, and neither the small  employer  nor  the  employee  shall  have reason to know that their coverage has been reinsured or pooled pursuant to  such regulations. Such regulations may also include other mechanisms designed to share risks or  prevent  undue  variations  in  insurer  and health  maintenance  organization  claim  costs which are not related to expected differences in  insurer  and  health  maintenance  organization costs  based  upon  competition, innovation and efficiency of operation. The regulations may segregate any reinsurance, pooling or other  process among  various  geographic  regions of the state. Prior to adopting such regulations  the  superintendent  shall  convene  a  technical  advisory committee to provide advice and recommendations to the superintendent on issues  including,  but  not limited to, voluntary reinsurance, pooling, risk sharing, the moderation of initial community rates as  compared  to prior  rates,  or  premium stabilization methods. The technical advisory committee shall be comprised of nine members, one of whom shall  be  the superintendent  or his or her designee. The superintendent or his or her designee shall chair the committee and shall appoint two  other  members to  the committee. The temporary president of the senate and the speaker of the assembly shall each appoint three members to the  committee.  The appointees  shall  be  representatives  of not-for-profit and commercial health insurers, health maintenance organizations, consumers  and  other purchasers  of  insurance  and  shall  be  named no later than September first, nineteen hundred ninety-five.   The superintendent shall also convene the technical advisory committee periodically to evaluate the impact of the standardized  direct  payment enrollee  contracts  offered  pursuant  to  sections four thousand three hundred twenty-one and four thousand three hundred  twenty-two  of  this chapter on the individual health insurance market. In the course of such evaluation,  the  superintendent  and  the  technical advisory committee shall  consider:  the  adequacy  of  the  benefits  provided  under  the contracts  and  their  effect  on  the  affordability  of the contracts; enrollment levels in the contracts in  various  regions  of  the  state; utilization and claims experience of the contract holders; the impact of  non-standardized  direct  payment  enrollee  contracts on the individual market; whether there is a need for an  additional  standardized  direct payment  enrollee  contract  and  recommendations  on  whether  other or different  standardized  benefit  packages  should  be  offered  in  the individual market; other options to enhance  the  affordability  of  the contracts;  and  such  other  areas  as the technical advisory committee deems appropriate. After completing such evaluation,  but  in  no  event later  than  October  first,  nineteen hundred ninety-six, the technical advisory committee shall deliver a report to the governor,  the  speaker of the assembly and the temporary president of the senate which contains the  results  of  its  evaluation and any findings or recommendations on enhancing access to and affordability  of  individual  health  insurance products.  (d)  Notwithstanding  any  provision  of  this  chapter  or  any other chapter, the superintendent may suspend or terminate, by regulation, the operation, in whole  or  in  part,  of  any  mechanism  established  and operating  pursuant  to  the authority of this section provided that the superintendent determines that the objectives stated in  subsection  (a) of  this  section  are met by the operation of a mechanism or mechanisms established by the federal government pursuant to section  1343  of  the affordable  care  act, 42 U.S.C. § 18063. Notwithstanding subsection (b) of this section, the superintendent may exercise this authority  without convening a technical advisory committee.