NY Ins L § 4704 (2021)
2021 New York Laws ISC - Insurance Article 47 - Municipal Cooperative Health Benefit Plans 4704 - Conditions for Issuance of Certificate of Authority.

§  4704.  Conditions for issuance of certificate of authority. (a) The superintendent shall issue a certificate of  authority  to  a  municipal cooperative  health  benefit  plan  if  all of the following conditions, after  examination   and   investigation,   have   been   met   to   the superintendent's satisfaction:  (1)  a  complete application has been filed with the superintendent in accordance with section  four  thousand  seven  hundred  three  of  this article;  (2)  except  for any plan that provided medical, surgical and hospital services on or  before  January  first,  nineteen  hundred  ninety-three pursuant  to  a municipal cooperation agreement, the number of municipal corporations participating in the municipal cooperative  health  benefit plan shall be at least three;  (3)  except  for any plan that provided medical, surgical and hospital services to at least three hundred fifty  covered  employees  (including retirees  and  not  including  dependents)  on  or before January first, nineteen  hundred  ninety-three  pursuant  to  a  municipal  cooperation agreement,  the  number of covered employees (including retirees and not including dependents) of municipal  corporations  participating  in  the municipal  cooperative  health  benefit  plan  shall  be  at  least  two thousand;  (4) the municipal cooperative health  benefit  plan  is  or  shall  be operated  pursuant  to  a municipal cooperation agreement satisfying the requirements set forth in section four thousand seven  hundred  five  of this article;  (5)  the  municipal cooperative health benefit plan has within its own organization adequate facilities and competent personnel to service  the plan  or,  in  order  to  provide  such  services, in whole or part, has contracted with a contract  administrator  or  other  service  provider, determined  by  the  governing  board to be qualified based upon written documentation furnished to  the  governing  board,  provided  that  such documentation  shall  be  made  available  to  the  superintendent  upon request;  (6) the municipal cooperative health benefit plan possesses a  written commitment,  binder  or  policy  for  stop-loss  insurance  issued by an insurance company authorized to do business in this state, to the extent required by section four thousand seven hundred seven of this article;  (7) the municipal cooperative health benefit plan establishes  premium equivalent  rates  sufficient to meet its contractual obligations and to satisfy the reserve and surplus requirements set forth in  section  four thousand seven hundred six of this article;  (8)  the  municipal  cooperative health benefit plan has established a fair and equitable process for claims  review,  dispute  resolution  and appeal   procedures   including  arbitration  of  rejected  claims,  and procedures for handling  claims  for  benefits  in  the  event  of  plan dissolution, which are satisfactory to the superintendent;  (9) the municipal cooperative health benefit plan has delivered to the superintendent  such  bond,  deposit  or  security for protection of the employees and retirees and their dependents covered by the plan  as  the superintendent  shall  require in the event that the plan's chief fiscal officer is not otherwise adequately bonded under the provisions  of  the education law, general municipal law or public officers law;  (10) the municipal cooperative health benefit plan provides to covered employees  and  retirees of participating municipal corporations written notice disclosing the information  required  by  section  four  thousand seven hundred nine of this article; and  (11)  all  plan documents, including the summary plan description, and amendments  thereto,  have  been  filed  with  and   approved   by   the  superintendent  in  accordance  with section four thousand seven hundred nine of this article.  (b)  The  superintendent  shall  refuse  to  grant  a  certificate  of authority to an applicant that fails to meet the  requirements  of  this section.   Notice of refusal shall be in writing and shall set forth the basis for the refusal. If the applicant submits a written request within thirty days after receipt of the notice of refusal,  the  superintendent shall  promptly  conduct a hearing to give the applicant the opportunity to show cause why the refusal should not be made final.  (c) After any municipal cooperative health  benefit  plan  receives  a certificate  of  authority,  it  may  be  joined by additional municipal corporations that execute a municipal  cooperation  agreement  identical with  the  instruments  in  effect  at  that  time  and  which the other participating municipal corporations have executed.