NY Ins L § 4702 (2021)
2021 New York Laws ISC - Insurance Article 47 - Municipal Cooperative Health Benefit Plans 4702 - Definitions.

§  4702.  Definitions. As used in this article: (a) "Community rating" means a rating methodology in which the premium equivalent rate for  all persons covered under a municipal cooperative health benefit plan is the same,  based  upon  the  experience  of the entire pool of risks covered under the plan, without regard to age, sex, health status or  occupation and  such  that  refunds,  rebates, credits or dividends based upon age, sex, health status or occupation are not permitted.  (b) "Fully-insured" means that all  benefits  payable  pursuant  to  a municipal  cooperative  health  benefit  plan  are  guaranteed  under  a contract or policy of insurance delivered in this state and issued by an insurance  company  authorized  to  do  accident  and  health  insurance business  in this state, an article forty-three corporation, or a health maintenance organization.  (c) "Governing board" means the group of persons,  designated  in  the municipal  cooperation  agreement establishing the municipal cooperative health benefit plan, to be responsible for administering the plan.  (d) "Municipal cooperation agreement" means an appropriate cooperative agreement authorized by article five-G of the general municipal law.  (e) "Municipal cooperative health benefit plan" or  "plan"  means  any plan  established  or  maintained  by two or more municipal corporations pursuant to  a  municipal  cooperation  agreement  for  the  purpose  of providing  medical,  surgical  or  hospital  services  to  employees  or retirees of such municipal corporations and to the  dependents  of  such employees or retirees.  (f) "Municipal corporation" means within the state of New York, a city with  a population of less than one million or a county outside the city of New York, town, village, board of cooperative  educational  services, school  district,  a  public  library, as defined in section two hundred fifty-three of the education law, or district, as defined in section one hundred nineteen-n of the general municipal law.  (g) "Plan document" means the group contract issued by  the  municipal cooperative  health benefit plan to participating municipal corporations describing the terms and conditions of coverage.  (h) "Premium  equivalent"   or   "contribution"   means   the   amount contributed  by  participating  municipal corporations to cover expected claims and  expenses  thereon,  required  reserves,  surplus,  stop-loss insurance,  and  other  expenses  associated  with the operations of the municipal cooperative health benefit plan.  (i) "Qualified actuary" means an actuary  who  is  a  member  in  good standing  of  the American Academy of Actuaries or Society of Actuaries, with experience in establishing rates for self-insured trusts  providing health benefits or other similar experience.  (j) "Summary  plan  description"  means the certificate of coverage or booklet delivered  to  employees  or  retirees  enrolled  in  the  plan, summarizing the essential terms and conditions of coverage for employees or retirees and their dependents.