NY Ins L § 4705 (2021)
2021 New York Laws ISC - Insurance Article 47 - Municipal Cooperative Health Benefit Plans 4705 - Municipal Cooperation Agreements.

§   4705.   Municipal   cooperation   agreements.  (a)  The  municipal cooperation agreement, under  which  the  municipal  cooperative  health benefit  plan  is established and maintained, and any amendment thereto, shall  be  approved  by  each  participating  municipal  corporation  by majority vote of each such corporation's governing body, and shall:  (1)  specify all municipal corporations participating in the municipal cooperative health benefit  plan  and  describe  the  form  or  type  of municipal corporations eligible for participation;  (2) state that all participating municipal corporations agree to share the  costs  of  and  assume  the  liabilities  for medical, surgical and hospital  benefits  provided  under  the  municipal  cooperative  health benefit  plan  to  the  covered employees (including retirees) and their dependents of all participating municipal corporations;  (3) state that each participating municipal corporation agrees to  pay on  demand  such municipal corporation's share of any assessment ordered by the governing board of the municipal cooperative health benefit  plan or  by  the superintendent under this article or article seventy-four of this chapter;  (4)  specify  the  eligibility  requirements  for  membership  in  and coverage  by  the  municipal  cooperative health benefit plan, including reasonable geographic boundaries (if any) of such plan, provided that no municipal cooperation agreement shall include any provision  restricting or  otherwise  limiting  the  right  to  participate  in  the  plan of a municipal corporation of the same type which provides satisfactory proof of  its  financial  responsibility  and  which  is  located  within  the geographic region in which the municipal cooperative health benefit plan operates;  (5)  not  include  any provision restricting or otherwise limiting the right of eligible employees (including retirees  and  dependents)  of  a participating municipal corporation to enroll for coverage in the plan;  (6)   designate  the  fiscal  officer  of  a  participating  municipal corporation to be the chief fiscal officer of the municipal  cooperative health benefit plan;  (7)  designate  the  plan's  attorney-in-fact  to  receive  service of summons or other legal process in any action, suit or proceeding arising out of any contract, agreement or transaction involving  such  municipal cooperative health benefit plan; and  (8)  establish a governing board to be responsible for the management, control and administration of the municipal cooperative  health  benefit plan,  provided  any municipal cooperative agreement to establish such a plan which is entered into after the  effective  date  of  this  article shall  provide that unions which are the exclusive collective bargaining representatives of employees who are covered by such health benefit plan shall be entitled to representation on such governing board.  (b) The municipal cooperation agreement shall provide that the  plan's chief fiscal officer:  (1)  shall  have  custody  of  all  moneys  received  by the municipal cooperative health benefit plan or made available for expenditure  under the plan;  (2) shall, notwithstanding any provision of the general municipal law, make  payment  in  accordance  with  procedures  developed by the plan's governing board and acceptable to the superintendent;  (3) may invest moneys not required for immediate  expenditure  in  the types  of  investment  specified  in  the  general  municipal law or the education law (as applicable) for temporary investments or as  otherwise expressly permitted by the superintendent; and  (4)  shall  receive  no  remuneration,  except  that the participating municipal  corporation  employing  the  chief  fiscal  officer  may   be  reimbursed  for  reasonable  expenses  incurred  in  connection with the duties of such fiscal officer in connection with the plan.  (c) A municipal cooperation agreement shall include a provision:  (1)  describing  the  composition,  number  and procedures under which governing board members are chosen, provided that, for those  agreements entered  into  after  the  effective date of this article, the governing board shall include representation by unions  which  are  the  exclusive collective  bargaining representatives of employees covered by the plan, and that such unions shall establish and  agree  to  the  procedures  by which  the  member  or  members  of  the governing board which represent unions are selected;  (2) designating one governing board member  to  have  custody  of  all reports, statements and other documents of the plan; and  (3)  that  the  governing board shall meet at least annually at a time and place in this state designated in accordance with the agreement.  (d)  The  municipal  cooperation  agreement  shall  provide  that  the governing board:  (1)  shall  design  the  plan  of  benefits  provided by the municipal cooperative health benefit  plan  and  prepare  the  plan  document  and summary  plan description in accordance with section four thousand seven hundred nine of this article;  (2) may enter into an agreement with a contract administrator or other service provider, determined by the governing board to be qualified,  to receive,  investigate,  recommend,  audit,  approve  or  make payment of claims under the municipal cooperative  health  benefit  plan,  provided that:  (A)  the  charges,  fees  and  other  compensation  for any contracted services shall be clearly  stated  in  written  administrative  services contracts  as required in subdivision six of section ninety-two-a of the general municipal law;  (B) payment for contracted services shall  be  made  only  after  such services are rendered;  (C)  no  member  of  the  plan's governing board or any member of such member's immediate family shall be an owner, officer, director, partner, or employee of any contract administrator retained by the plan; and  (D)  all  such  agreements  shall  comply  with  the  requirements  of subdivision six of section ninety-two-a of the general municipal law.  (3) shall be authorized to purchase stop-loss insurance, to the extent required  by  section four thousand seven hundred seven of this article, on behalf of the municipal cooperative health benefit plan;  (4) shall be authorized to establish a joint fund or funds to  finance all    plan   expenditures,   including   claims,   reserves,   surplus, administration, stop-loss insurance and other expenses;  (5) shall prepare an  annual  budget  for  the  municipal  cooperative health  benefit  plan  to  determine  the  premium  equivalent rates for participating municipal corporations to be deposited in the plan's joint fund or funds during the fiscal year, provided that:  (A) the governing board shall designate the bank or trust  company  in which  joint  funds,  including  reserve  funds, are to be deposited and which shall be located in this state, duly chartered under  federal  law or the laws of this state; and  (B)  the  governing board shall establish premium equivalent rates for participating municipal corporations on the bases of a community  rating methodology  filed  with  and  approved  by  the  superintendent and, in determining the annual premium equivalent rates, the governing board:  (i) may contract for necessary actuarial services to estimate expected plan expenditures during the fiscal year;  (ii) shall maintain reserves in amounts  equal  to  or  exceeding  the minimum  amounts  required by section four thousand seven hundred six of this article; and  (iii)  shall  maintain  a  stop-loss policy or policies, to the extent required by section four thousand seven hundred seven of this article;  (6) shall be authorized to assess participating municipal corporations for additional contributions, if actual losses due to benefits paid out, administrative expenses and  reserve  and  surplus  requirements  exceed amounts held in the plan's joint funds; and  (7)  shall  be  authorized to refund amounts in excess of reserves and surplus required by section four thousand  seven  hundred  six  of  this article   and   anticipated  expenses  in  the  plan's  joint  funds  to participating municipal corporations, or to retain such  excess  amounts or  a  portion  thereof  and  apply such amounts in preparing the plan's budget for the following year.  (e)  The  municipal  cooperation  agreement  shall  provide  for   the following  to  be  prepared  and  furnished  to  the governing board, to participating municipal corporations, to unions which are the  exclusive bargaining  representatives  of employees covered by the plan and to the superintendent:  (1) an annual audit, and opinions thereon, by an independent certified public accountant, of the financial condition, accounting procedures and internal control systems of the  municipal  cooperative  health  benefit plan;  (2)  an  annual  report  and  quarterly  reports describing the plan's current financial status; and  (3) an annual independent actuarial opinion on the financial soundness of the plan,  including  the  actuarial  soundness  of  contribution  or premium  equivalent rates and reserves, both as paid in the current year and projected for the next fiscal year.  (f) The municipal cooperation agreement shall specify the  rights  and obligations  of  a  municipal  corporation  withdrawing from a municipal cooperative  health  benefit  plan  to  any  contribution  (or   premium equivalent)  refund  or  reserve  fund  or for any contingent assessment liability or other obligation.  (g) Every municipal cooperation agreement shall  contain  a  provision stating  that  nothing contained in such agreement shall be construed to waive  any  right  a  covered  person  possesses  with  respect  to  the confidentiality  of  medical  records  and  that  such right may only be waived upon the written consent of such covered person.