Selected Health Related Regulations

• Summaries of Recently Adopted Health Related Regulations
• Text of Recently Adopted Health Related Regulations

Summaries of Recently Adopted Health Related Regulations

Twenty-Third Amendment to Regulation No. 62
Fourth Amendment to Regulation No. 145
First Amendment to Regulation No. 146

In 1996, federal legislation was enacted which is known as the Health Insurance Portability and Accountability Act, or Kassebaum - Kennedy. This legislation is intended to facilitate the ability for individuals to purchase or retain health insurance and to change from one health plan to another.

In 1997, New York enacted Chapter 661 to amend existing state laws to conform to the requirements for availability, portability and renewability of health insurance coverage enacted in the federal legislation. The Twenty Third Amendment to Regulation 62, the Fourth Amendment to Regulation 145 and the First Amendment to Regulation 146 make these regulations consistent with the aforementioned federal law and state statutory requirements, while also retaining and enhancing consumer protections present in the regulations as previously adopted. New York law and the regulations, as amended, address the following areas:

• In New York, your ability to purchase health insurance does not depend on your health status.

• Group insurance is available to all group members without special limits or added cost based on your health status.

• New York has limits on preexisting conditions limitations. There are rules concerning what constitutes a preexisting condition and the length of any waiting period that can be imposed on a preexisting condition. As a general rule, the amount of time you were covered under a prior plan counts toward satisfaction of any waiting period in a new plan if there has not been a break in coverage of longer than 63 days.

• Insurance cannot be terminated if you become ill.

• Individual and small group coverage is available on an open enrollment and guaranteed issue basis.

• The cost for individual health and small group health insurance is the same for all. It cannot change based on health status, age, sex, or occupation.

Twenty-Second Amendment to Regulation No. 62
Fifth Amendment to Regulation No. 145
Second Amendment to Regulation No. 146

The Twenty Second Amendment to Regulation 62, the Fifth Amendment to Regulation 145 and the Second Amendment to Regulation 146 address various aspects of the regulatory requirements applicable to specified disease coverage. Until these amendments, this type of coverage, which provides benefits only for the named diseases or conditions, was not available in New York. These amendments are intended to respond to consumer demand for this type of insurance by providing consumers with enhanced individual choice and permitting New Yorkers to make their own financial decisions. These products enable New Yorkers to choose additional layers of protection, assist them in covering expenses not otherwise covered by comprehensive health coverage, and provide consumers with a choice of products. Individuals facing serious medical conditions often face significant financial losses beyond those addressed by traditional comprehensive coverage (i.e. lost wages, travel expenses, etc.). Specified disease coverage can provide consumers with an additional form of protection from such financial losses. New Yorkers are not forced to go outside of the state and outside of the protection of New York’s laws and regulations in order to purchase specified disease coverage.

Under the revised regulations specified disease coverage can only be issued to individuals who are also covered by major medical insurance, or by both basic hospital and basic medical insurance. Minimum loss ratios are established to make certain that a meaningful level of benefits are paid under these contracts. Minimum loss ratios and the other minimum standards are designed to ensure that the supplemental coverage is meaningful coverage that provides for a meaningful transfer of risk to the insurer.

Links to the Text of Recently Adopted Health Related Regulations

Twenty Second Amendment to Regulation 62 (11 NYCRR 52): Minimum Standards for Form, Content, and Sale of Health Insurance, Including Standards of Full and Fair Disclosure
Promulgated Date: March 31, 1998
Effective Date: April 15, 1998

Twenty-Third Amendment to Regulation No. 62 (11 NYCRR 52): Minimun Standards for Form, Content and Sale of Health Insurance, Including Standards of Full and Fair Disclosure
Promulgated Date: July 14, 1998
Effective Date: July 29, 1998

Fourth Amendment to Regulation No. 145 (11 NYCRR 360): Rules to Assure an Orderly Implementation and Ongoing Operation of Open Enrollment and Community Rating of Individual and Small Group Health Insurance
Promulgated Date: July 14, 1998
Effective Date: July 29, 1998

First Amendment to Regulation No. 146 (11 NYCRR 361): Establishment and Operation of Market Stabilization Mechanisms for Individual and Small Group Health Insurance and Medicare Supplement Insurance
Promulgated Date: July 14, 1998
Effective Date: July 29, 1998

Fifth Amendment to Regulation 145 (11 NYCRR 360): Rules to Assure an Orderly Implementation and Ongoing Operation of Open Enrollment and Community Rating of Individual and Small Group Health Insurance
Promulgated Date: November 2, 1998
Effective Date: November 18, 1998

Second Amendment to Regulation 146 (11 NYCRR 361): Establishment and Operation of Market Stabilization Mechanisms for Individual and Small Group Health Insurance and Medicare Supplement Insurance
Promulgated Date: November 2, 1998
Effective Date: November 18, 1998

Twenty-Fourth Amendment to Regulation 62 (11 NYCRR 52): Minimum Standards for the Form, Content and Sale of Health Insurance, Including Standards of Full and Fair Disclosure
Promulgated Date: October 18, 1999
Effective Date: November 3, 1999

Twenty-Fifth Amendment to Regulation 62 (11 NYCRR 52): Minimum Standards for the Form, Content and Sale of Health Insurance; Dental Care Exclusion; Including Standards of Full and Fair Disclosure
Promulgated Date: November 18, 1999
Effective Date: December 8, 1999

Regulation 164 (11 NYCRR 101): Standards for Financial Risk Transfer Between Insurers and Health Care Providers
Effective Date: August 22, 2001

First Amendment to Regulation 164 (11 NYCRR 101): Standards for Financial Risk Transfer Between Insurers and Health Care Providers
Effective Date: January 30, 2002