N.Y. Comp. Codes R. & Regs. Tit. 11 § 52.52 - [Effective 7/31/2025] Demographic information to promote health equity

(a) An insurer shall request information regarding an insured's and a covered dependent's race, ethnicity, preferred language, sexual orientation, and gender identity or expression for all insureds and dependents covered under a comprehensive health insurance policy, provided that:

(1) an insurer shall request and collect such demographic information via a separate and supplemental questionnaire:

(i) after an applicant has completed an application for a comprehensive health insurance policy; and

(ii) with respect to insureds and dependents already covered under a policy as of the effective date of this section, at the time of the next policy renewal that is at least 90 days after the effective date of this section and at any later time upon the direction of the superintendent, provided that the superintendent shall not direct an insurer to request and collect demographic information from insureds and dependents more than once every two years;

(2) an insured's or covered dependent's response shall be optional;

(3) an insurer shall not use the demographic information received in a manner that would constitute unfair or unlawful discrimination under the laws of this State, including, but not limited to, Insurance Law sections 2606 and 2607; and

(4) an insurer's use, distribution, or sale of the demographic information shall be consistent with applicable Federal and State statutes and regulations, including 45 C.F.R. Part 160 and Subparts A and E of Part 164 of 45 C.F.R.¹, Insurance Law sections 3221(q)(1) and 4305(k)(1), and Part 420 of this Title, provided that:

(i) an insurer shall not sell to any third-party any demographic information received, including any information that has been de-identified; and

(ii) an insurer shall not share with any third-party, or allow any third party to collect on its behalf, any demographic information, including any information that has been de-identified, unless the third party agrees not to sell or share the information, except when required by law, and the third-party agrees to keep the information confidential.

(b) Limitations on the use of demographic information. No insurer shall use the demographic information received for:

(1) any underwriting determinations, including eligibility determinations, or for rating purposes, and an insurer may not base any decision relating to such underwriting or rating on an individual's refusal to provide a response to a request made pursuant to paragraph (1) of subdivision (a) of this section; or

(2) any effort to solicit an insured or covered dependent to purchase or use any product or service, with the exception of:

(i) using the preferred language of an insured or covered dependent to communicate with that insured or covered dependent;

(ii) efforts to eliminate health disparities, as defined under Public Health Law section 240(6); and

(iii) efforts to promote health equity, as defined under Public Health Law section 240(7).

(c) An insurer shall clearly and conspicuously disclose in the separate supplemental questionnaire required under paragraph (1) of subdivision (a) of this section that:

(1) an insured or a covered dependent may refuse to provide any demographic information requested pursuant to paragraph (1) of subdivision (a) of this section;

(2) the insurer may not use the demographic information for any underwriting determinations, including eligibility determinations, or for rating purposes, and an insurer may not base any decision relating to such underwriting or rating on an individual's refusal to provide a response to a request made pursuant to paragraph (1) of subdivision (a) of this section;

(3) the insurer is prohibited from using the demographic information provided in response to a request made pursuant to paragraph (1) of subdivision (a) of this section in a manner that would constitute unfair or unlawful discrimination under the laws of this State, including, but not limited to, Insurance Law sections 2606 and 2607;

(4) any demographic information provided in response to a request made pursuant to paragraph (1) of subdivision (a) of this section will be maintained as confidential consistent with applicable Federal and State statutes and regulations; and

(5) the insurer is requesting demographic information from insureds and covered dependents pursuant to this section in order to support efforts to promote health equity, and the insured may receive information from the insurer in connection with an insurer's health equity programs or services.

(d) Reporting. An insurer shall provide to the superintendent, upon the superintendent's request, and in a format specified by the superintendent, all demographic information received.

(e) Signed attestation. An insurer shall electronically file with the superintendent, in connection with any rate filing or rate manual submission, a document signed by the highest-ranking executive responsible for oversight of rates and by a senior officer directly responsible for oversight of rates attesting that the demographic information received is not used in underwriting, including eligibility determinations, for rating, or otherwise used in a manner that would constitute unfair or unlawful discrimination under the laws of this State, including, but not limited to, Insurance Law sections 2606 and 2607, provided, however, that the insurer may apply to the superintendent for an exemption from the electronic filing requirement as set forth in section 6.3 of Part 6 of this Title.

(f) Collection and retention of demographic information. An insurer shall compile and maintain a record of the demographic information provided by an insured or covered dependent pursuant to a request under paragraph (1) of subdivision (a) of this section, or a record that an insured or covered dependent declined to provide such information, in accordance with Part 243 of this Title.

(g) As used in this section, ''insurer" means an insurer licensed to write accident and health insurance in this State, a corporation organized pursuant to Insurance Law article 43, a health maintenance organization certified pursuant to Public Health Law article 44, and a student health plan certified pursuant to Insurance Law section 1124.

Notes

N.Y. Comp. Codes R. & Regs. Tit. 11 § 52.52

Adopted New York State Register April 2, 2025/Volume XLVII, Issue 13, eff. 7/31/2025