N.Y. Ins. Law § 3239

§ 3239. Wellness programs. (a) An insurer licensed to write accident\nand health insurance, a corporation organized pursuant to article\nforty-three of this chapter, a health maintenance organization certified\npursuant to article forty-four of the public health law and a municipal\ncooperative health benefits plan may establish a wellness program in\nconjunction with its issuance of a group accident and health insurance\npolicy or group subscriber contract. A "wellness program" is a program\ndesigned to promote health and prevent disease that may contain rewards\nand incentives for participation. Participation in the wellness program\nshall be available to similarly-situated members of the group and shall\nbe voluntary on the part of the member. The terms of the wellness\nprogram shall be set forth in the policy or contract.\n * (b) A wellness program may include, but is not limited to, the\nfollowing programs or services:\n (1) the use of a health risk assessment tool;\n (2) a smoking cessation program;\n (3) a weight management program;\n (4) a stress management program;\n (5) a worker injury prevention program;\n (6) a nutrition education program;\n (7) health or fitness incentive programs; and\n (8) a coordinated weight management, nutrition, stress management and\nphysical fitness program to combat the high incidence of adult and\nchildhood obesity, asthma and other chronic respiratory conditions.\n * NB Effective until January 17, 2017\n * (b) A wellness program may include, but is not limited to, the\nfollowing programs or services:\n (1) the use of a health risk assessment tool;\n (2) a smoking cessation program;\n (3) a weight management program;\n (4) a stress and/or hypertension management program;\n (5) a worker injury prevention program;\n (6) a nutrition education program;\n (7) health or fitness incentive programs;\n (8) a coordinated weight management, nutrition, stress management and\nphysical fitness program to combat the high incidence of adult and\nchildhood obesity, asthma and other chronic respiratory conditions;\n (9) a substance or alcohol abuse cessation program; and\n (10) a program to manage and cope with chronic pain.\n * NB Effective January 17, 2017\n * (c)(1) A wellness program may use rewards and incentives for\nparticipation provided that where the group health insurance policy or\nsubscriber contract is required to be community-rated, the rewards and\nincentives shall not include a discounted premium rate or a rebate or\nrefund of premium.\n (2) Permissible rewards and incentives include:\n (A) full or partial reimbursement of the cost of participating in\nsmoking cessation or weight management programs;\n (B) full or partial reimbursement of the cost of membership in a\nhealth club or fitness center;\n (C) the waiver or reduction of copayments, coinsurance and deductibles\nfor preventive services covered under the group policy or subscriber\ncontract;\n (D) monetary rewards in the form of gift cards or gift certificates,\nso long as the recipient of the reward is encouraged to use the reward\nfor a product or a service that promotes good health, such as healthy\ncook books, over the counter vitamins or exercise equipment;\n (E) full or partial reimbursement of the cost of participating in a\nstress management program or activity; and\n (F) full or partial reimbursement of the cost of participating in a\nhealth or fitness program.\n (3) Where the reward involves a group member's meeting a specified\nstandard based on a health condition, the wellness program must meet the\nrequirements of 45 CFR Part 146.\n (4) A reward or incentive which involves a discounted premium rate or\na rebate or refund of premium shall be based on actuarial demonstration\nthat the wellness program can reasonably be expected to result in the\noverall good health and well being of the group.\n * NB Effective until January 17, 2017\n * (c)(1) A wellness program may use rewards and incentives for\nparticipation provided that where the group health insurance policy or\nsubscriber contract is required to be community-rated, the rewards and\nincentives shall not include a discounted premium rate or a rebate or\nrefund of premium.\n (2) Permissible rewards and incentives may include:\n (A) full or partial reimbursement of the cost of participating in\nsmoking cessation, weight management, stress and/or hypertension, worker\ninjury prevention, nutrition education, substance or alcohol abuse\ncessation, or chronic pain management and coping programs;\n (B) full or partial reimbursement of the cost of membership in a\nhealth club or fitness center;\n (C) the waiver or reduction of copayments, coinsurance and deductibles\nfor preventive services covered under the group policy or subscriber\ncontract;\n (D) monetary rewards in the form of gift cards or gift certificates,\nso long as the recipient of the reward is encouraged to use the reward\nfor a product or a service that promotes good health, such as healthy\ncook books, over the counter vitamins or exercise equipment;\n (E) full or partial reimbursement of the cost of participating in a\nstress management program or activity; and\n (F) full or partial reimbursement of the cost of participating in a\nhealth or fitness program.\n (3) Where the reward involves a group member's meeting a specified\nstandard based on a health condition, the wellness program must meet the\nrequirements of 45 CFR Part 146.\n (4) A reward or incentive which involves a discounted premium rate or\na rebate or refund of premium shall be based on actuarial demonstration\nthat the wellness program can reasonably be expected to result in the\noverall good health and well being of the group.\n * NB Effective January 17, 2017\n