New York Laws
Article 32 - Insurance Contracts - Life, Accident and Health, Annuities
3233 - Stabilization of Health Insurance Markets and Premium Rates.

(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.

Structure New York Laws