N.Y. Insurance Law § 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.