New York Assembly Bill A08763

New York 2025-2026 Regular Session

• Introduced: 6/2/25
• Refer: 6/2/25
• Refer: 1/7/26

Caption

Amends the definition of "small group" for purposes of health insurance policies and contracts to fifty employees or fewer; repeals provisions requiring the superintendent to conduct an impact study.

Summary

This bill narrows New York’s statutory definition of a “small group” for health insurance purposes from groups of up to 100 employees or members back down to groups of 50 or fewer. It amends multiple provisions of the Insurance Law governing both health insurance policies and health insurance contracts so that community rating, preexisting-condition limitations, and related small-group rules apply only to the smaller 1-50 employee market. The bill also updates parallel rules for out-of-state trust coverage and association/trust arrangements so that member employers with 50 or fewer employees are treated as small groups for rating purposes. The bill further removes the temporary 2016 exceptions that had allowed certain stop-loss, catastrophic, and reinsurance coverage arrangements for 51-100 employee groups, and it repeals a 2016 law requiring the superintendent of financial services to commission an independent study on the impact of the stop-loss prohibition. The measure takes effect immediately, while preserving the existing expiration and reversion dates for certain related paragraphs in the Insurance Law. Its practical impact is to reduce the size of the small-group market under New York law, which would likely affect premium rating, underwriting rules, and insurer obligations for employers and other group purchasers with 51-100 employees or members. Those larger small-group employers would no longer be treated as small groups under the amended provisions, and the bill would also eliminate the statutory study requirement tied to the earlier stop-loss/reinsurance restrictions. The available context shows no recorded committee transcript or vote history, so there is no documented public debate in the provided materials. Based on the bill’s structure, the likely policy sentiment is a technical rollback of the 2016 expansion rather than a broad new insurance reform. The main point of contention, if any, would be the treatment of 51-100 employee groups: whether they should continue to receive small-group protections and access to stop-loss or reinsurance-related arrangements, or be returned to the larger-group framework.

Impact

The bill amends Insurance Law sections 3231 and 4317 to redefine “small group” as 50 or fewer employees or members, affecting both health insurance policies and contracts, including Medicare supplemental coverage. It also revises related association/trust rating provisions so that only member employers with 50 or fewer employees are treated as small groups for rating purposes. In addition, it repeals a 2016 statutory requirement for an independent assessment of the impact of the stop-loss/catastrophic/reinsurance prohibition, and it removes the temporary exceptions that had applied to certain 51-100 employee groups.

Sentiment

No committee transcripts or votes were provided, so there is no direct record of support or opposition in the supplied materials. The bill appears to be a targeted technical policy reversal of prior expansion to 100 employees, suggesting a generally administrative or corrective posture rather than a highly contested overhaul. The absence of recorded debate makes the overall sentiment difficult to gauge beyond the bill’s clear intent to narrow the small-group market and eliminate a related study mandate.

Contention

The central policy dispute is the treatment of employers and groups with 51-100 employees or members. Supporters would likely view the bill as restoring the traditional small-group boundary and simplifying insurance regulation, while opponents could argue that it reduces protections and market access for mid-sized employers, especially regarding community rating and stop-loss/reinsurance coverage. Another possible point of contention is the repeal of the independent impact study, which removes a formal mechanism for evaluating the consequences of the earlier prohibition.