New York Insurance Code § 3233

Stabilization of health insurance markets and premium rates
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§ 3233. Stabilization of health insurance markets and premium rates.\n(a) Notwithstanding any provision of this chapter or any other chapter,\non or before October first, nineteen hundred ninety-two the\nsuperintendent shall promulgate regulations to assure an orderly\nimplementation and ongoing operation of the open enrollment and\ncommunity rating required by sections thirty-two hundred thirty-one and\nforty-three hundred seventeen of this chapter, including provisions\ndesigned to encourage insurers to remain in or enter the small group or\nindividual health insurance markets. The regulations shall apply to all\ninsurers and health maintenance organizations subject to community\nrating. The regulations shall be designed to promote an insurance\nmarketplace where premiums do not unduly fluctuate, insurers and health\nmaintenance organizations are reasonably protected against unexpected\nsignificant shifts in the number of persons insured, and other market\nstability features deemed appropriate by the superintendent. Such\nregulations shall not require any insurer or health maintenance\norganization subject to this section, or any subsidiary or controlled\nperson of a holding company of such insurer or health maintenance\norganization, to enter, continue to conduct, or withdraw from any line\nof business as a condition of entering, continuing in, or withdrawing\nfrom any other line of business.\n  (b) Prior to adopting such regulations the superintendent shall\nconvene a technical advisory committee to provide advice and\nrecommendations to the superintendent on issues including, but not\nlimited to, voluntary reinsurance, pooling, risk sharing, the moderation\nof initial community rates as compared to prior rates, or premium\nstabilization methods. The technical advisory committee shall be\ncomprised of nine members, one of whom shall be the superintendent or\nhis or her designee. The superintendent or his or her designee shall\nchair the committee and shall appoint two other members to the\ncommittee. The temporary president of the senate and the speaker of the\nassembly shall each appoint three members to the committee. The\nappointees shall be representatives of commercial health insurers,\nnot-for-profit health insurers, health maintenance organizations and\npurchasers of insurance and shall be named no later than July fifteenth,\nnineteen hundred ninety-two. In addition, the superintendent may obtain\nthe services of an actuary with experience relating to premium rates and\nmarket stabilization for small group health insurance.\n  (c) (1) Such regulations shall include reinsurance or a pooling\nprocess involving insurer contributions to, or receipts from, a fund\nwhich shall be designed to share the risk of or equalize high cost\nclaims, claims of high cost persons, cost variations among insurers and\nhealth maintenance organizations based upon demographic factors of the\npersons insured which correlate with such cost variations designed to\nprotect insurers from disproportionate adverse risks of offering\ncoverage to all applicants; provided that such regulations shall relate\nonly to risk sharing among insurers and health maintenance organizations\nand shall not create differences in community rates charged by a single\ninsurer because an individual's or small group's coverage has been\nreinsured or pooled, and neither the small employer nor the employee\nshall have reason to know that their coverage has been reinsured or\npooled pursuant to such regulations. Such regulations may also include\nother mechanisms designed to share risks or prevent undue variations in\ninsurer claim costs which are not related to expected differences in\ninsurer costs based upon competition, innovation and efficiency of\noperation. The regulations may segregate any reinsurance, pooling or\nother process among various geographic regions of the state.\n  (2) Effective on and after January first, nineteen hundred ninety-six,\nhealth maintena

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