2023 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.