2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3239 - Wellness Programs.

§  3239.  Wellness  programs.  (a)  An  insurer licensed to write life
insurance may establish a  wellness  program  in  conjunction  with  its
issuance  of  life  insurance  policies and an insurer licensed to write
accident and health  insurance,  a  corporation  organized  pursuant  to
article  forty-three  of this chapter, a health maintenance organization
certified pursuant to article forty-four of the public health law and  a
municipal  cooperative  health  benefits  plan  may establish a wellness
program in conjunction with its issuance of a group accident and  health
insurance policy or group subscriber contract. A "wellness program" is a
program  designed  to  promote health, longevity or prevent disease that
may contain  rewards  and  incentives  for  participation.  A  "wellness
program"   shall   not   include   limited  benefits  health  insurance.
Participation  in  the  wellness   program   shall   be   available   to
similarly-situated   members  of  the  group  or  with  regard  to  life
insurance, to all insureds within the same class and  equal  expectation
of  life  and  shall  be voluntary on the part of the member or insured.
With regard to life insurance, an insurer is prohibited from  increasing
premiums or charges stated in the policy as a result of participation or
non-participation  in  the  program.  The  terms of the wellness program
shall be set forth in the policy or contract. With regard to a  wellness
program  established in connection with life insurance, an insurer shall
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.
(b) A wellness program  may  include,  but  is  not  limited  to,  the
following programs or services:
(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)(1)   A  wellness  program  may  use  rewards  and  incentives  for
participation provided that where the group health insurance  policy  or
subscriber  contract  is required to be community-rated, the rewards and
incentives shall not include a discounted premium rate or  a  rebate  or
refund of premium.
(2) Permissible rewards and incentives may include:
(A)  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;
(B) full or partial reimbursement of  the  cost  of  membership  in  a
health club or fitness center;
(C)  (1)  the  waiver  or  reduction  of  copayments,  coinsurance and
deductibles for preventive  services  covered  under  the  group  health
insurance policy or subscriber contract;
(2)  a  premium  refund,  discount,  or  policy value credit, or other
increase in benefits or decrease  in  charges  under  a  life  insurance
policy;
(D)  monetary  rewards  in  the form of gift cards, gift certificates,
vouchers or discounts on products or services in return for engaging  in
healthy behaviors;
(E)  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, well being,
or improved mortality risk;
(F) full or partial reimbursement of the cost of  participating  in  a
health or fitness program; and
(G) 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.
(3)  Where  the  reward  involves a group member's meeting a specified
standard based on a health  condition,  the  wellness  program  under  a
health insurance policy shall meet the requirements of 45 CFR Part 146.
(4) A reward or incentive that involves a discounted premium rate or a
rebate or refund of premium under accident and health insurance policies
shall  be based on actuarial demonstration that the wellness program can
reasonably be expected to result in the overall  good  health  and  well
being  of the group. A premium refund, discount, or policy value credit,
or other  increase  in  benefits  or  decrease  in  charges  under  life
insurance  policies in connection with a wellness program shall be based
on  sound  actuarial  principles  related  to   actual   or   reasonably
anticipated experience.
(d)  Fair  collection  and  use of personal information. (1) Nonpublic
personal information, including health data,  an  insurer  collects  and
shares  in  connection  with  a wellness program shall be subject to all
state and federal privacy and security laws and regulations  promulgated
thereunder, including 11 NYCRR 420.
(2)  Wellness  program  participants  shall have the right to obtain a
copy of their wellness program information and an opportunity to correct
any inaccuracies.
(3) An insurer may  contract  with  a  third  party  for  purposes  of
administering  or  operating a wellness program on such insurer's behalf
provided that the insurer maintains a system of  supervision  to  ensure
compliance  with  this section, including procedures to take appropriate
corrective action for any participant harmed  by  a  violation  of  this
section  by  the  insurer  directly  or by any third party with whom the
insurer contracts.