Which insurers must comply with the regulation?
The regulation applies to insurers licensed to write accident and health insurance in New York State, corporations organized pursuant to Insurance Law Article 43, HMOs certified pursuant to Public Health Law Article 44, and student health plans certified pursuant to Insurance Law § 1124 in relation to comprehensive health insurance policies.
The regulation does not apply to self-funded plans, municipal cooperative health benefit plans, or government-sponsored health plans, such as Medicaid managed care plans, Child Health Plus, or the Essential Health Plan.
When does the regulation take effect?
The regulation is effective July 31, 2025. Insurers must begin collecting demographic information on and after that date.
What demographic information must insurers request from insureds under the regulation?
Insurers must request information regarding an insured’s race, ethnicity, preferred language, sexual orientation, and gender identity or expression.
The Department has provided a Sample Form Template: Questionnaire to Support Health Equity that lists the demographic information that insurers must request.
The template questionnaire corresponds to questions and response fields already required to be used by many insurers by state and federal agencies. Consistent data collection will ensure that insurers develop effective data sources across commercial and public plans.
How should insurers collect this demographic information?
Insurers should use a questionnaire that requests that insureds voluntarily provide the demographic information. The Department has provided a Sample Form Template: Questionnaire to Support Health Equity that insurers may use to collect the demographic information to comply with the regulation.
May insurers send the questionnaire to insureds electronically?
Yes, insurers may send the questionnaire to insureds electronically if the insured or covered dependent has consented to receiving the questionnaire electronically.
Must insureds answer the demographic questions?
No, responses are voluntary. Insureds are not required to respond to the demographic questions.
How will insureds know that they do not have to provide their demographic information?
When insurers request demographic information, they must disclose, in writing, that insureds may refuse to provide any requested demographic information. The template questionnaire contains model language that will help make this point clear to insureds.
What must insurers disclose to insureds when they request demographic information?
Insurers must disclose that:
- Insureds may refuse to provide any requested demographic information;
- The insurer is prohibited from using the demographic information (or the insured’s refusal to provide the information) for underwriting determinations, including eligibility determinations, or rating purposes;
- The insurer may not use the demographic information in a manner that would constitute unfair or unlawful discrimination under state law;
- The insurer will keep any demographic information that is provided confidential consistent with state and federal law and regulations; and
- The insurer is requesting demographic information to support efforts to promote health equity, and the insured may receive information from the insurer in connection with the insurer’s health equity programs or services.
When must insurers collect the demographic information?
Insurers must request the demographic information after an insured has completed an application for a comprehensive health insurance policy.
For insureds who are already covered under a policy, for whom the insurer does not have such information when the regulation becomes effective, the issuer must request the demographic information at the first policy renewal that is at least 90 days after the effective date of the regulation.
Must an insurer follow-up if an insured does not respond to the request for demographic information?
No, the regulation does not require an insurer to follow-up if an insured does not respond, but an insurer may choose to do so.
How often should insurers ask about potential changes to demographic information for insureds covered under a health insurance policy?
The regulation requires insurers to ask insureds for this information after completing an application for a comprehensive health insurance policy (or one time upon the first policy renewal after the regulation becomes effective if the insurer does not have the information); however, the regulation does not preclude insurers from asking for this information more frequently.
How may insurers use the demographic information?
The regulation permits insurers to use the demographic information to communicate with insureds using preferred language and to support insurers’ efforts to eliminate health disparities and to promote health equity.
May insurers use an insured’s response or refusal to respond to a demographic question as a basis for any underwriting determination, including eligibility determinations or rating purpose?
No, insurers may not use an insured’s response or refusal to respond to any demographic question as a basis for any underwriting determination, including eligibility determinations or rating purpose.
May insurers use the demographic information collected to solicit an insured to purchase or use any service or product?
No, insurers may not use the demographic information collected to solicit an insured. However, insurers may use the preferred language of an insured to communicate with that insured, and insurers may use the demographic information to support efforts to eliminate health disparities and to promote health equity.
Does the regulation require insurers to obtain questionnaire responses from a certain number or percentage of insureds?
No, the regulation does not require insurers to obtain questionnaire responses from a certain number or percentage of insureds.
Does the regulation specify how insurers must maintain the demographic information collected pursuant to the regulation?
Yes, the regulation requires insurers to keep the demographic information confidential consistent with federal and state laws and regulations.
Additionally, the regulation requires insurers to maintain a record of the demographic information collected in accordance with 11 NYCRR 243, which sets forth insurer record retention requirements.
Must insurers request and collect demographic information as required by the regulation if the New York State of Health (NYSOH) already collects the same information?
Yes, insurers must request the demographic information required by the regulation even if NYSOH already collects the information.
How does the regulation protect against discrimination?
The regulation expressly prohibits insurers from using the demographic information in a manner that would constitute unfair or unlawful discrimination under state law. It further prohibits insurers from using the responses (or lack thereof) for underwriting determinations, including eligibility determinations, and rating purposes. Insurers must file annual attestations with the Department that attest to the foregoing.
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