2023 New York Laws › ISC - Insurance › Article 47 - Municipal Cooperative Health Benefit Plans › 4703 - Application for Certificate of Authority.

§  4703.  Application  for  certificate of authority. (a) No municipal
corporation shall establish, maintain  or  otherwise  participate  in  a
municipal  cooperative  health benefit plan in this state which provides
benefits, in whole or  part,  on  a  shared-funding  basis,  unless  the
municipal cooperative health benefit plan:
(1)  obtains  and  maintains  a  certificate  of  authority  from  the
superintendent pursuant to the provisions of this article; or
(2) is an employee welfare fund, as defined in article  forty-four  of
this  chapter  that is administered by equal representation of employees
and employers; or
(3) is exempt from the requirement of obtaining a license; or
(4) is, and continues to be,  a  fully-insured  municipal  cooperative
health benefit plan.
(b) The governing board shall file an application for a certificate of
authority  on  such  form as the superintendent may prescribe, and shall
provide to the satisfaction of the superintendent the following:
(1) a list of every participating municipal  corporation,  the  names,
addresses  and  official  titles  of the members of the plan's governing
board, and name and principal address  of  the  plan's  attorney-in-fact
designated pursuant to the municipal cooperation agreement;
(2) evidence that the plan's chief fiscal officer is adequately bonded
in a manner acceptable to the superintendent, who may accept or consider
for  this  purpose  any bond required under the applicable provisions of
the education law, general municipal law or public officers law;
(3) a copy of  the  municipal  cooperation  agreement  and  all  other
documents  describing  the  rights  and  obligations  of  the  municipal
corporations participating in the municipal cooperative  health  benefit
plan;
(4)  a  copy of all documents, including the summary plan description,
furnished  to  the  participating  municipal  corporations   and   their
employees or retirees describing plan benefits;
(5)  a  copy  of  all  agreements  between  the  plan and each service
provider, including any contract administrator;
(6) a qualified actuary's opinion, in form and substance  satisfactory
to  the  superintendent,  accompanied  by a memorandum, also in form and
substance   satisfactory   to   the   superintendent,   describing   the
calculations,  assumptions  and  methodology  made  in  support  of such
opinion,  that  the  municipal  cooperative  health  benefit   plan   is
actuarially   sound   and   that  premium  equivalent  rates  have  been
established at a level sufficient to maintain reserves  as  required  by
section four thousand seven hundred six of this article;
(7)  a statement, certified by the governing board, that aggregate and
specific stop-loss coverage shall be obtained  and  maintained,  to  the
extent  required  by  section  four thousand seven hundred seven of this
article, and a copy of  the  written  commitment,  binder  or  stop-loss
policy or policies;
(8)  a  proposed  plan  of  operation  and  funding  for the municipal
cooperative health benefit plan, setting forth:
(A) the current or proposed premium equivalent rates  to  provide  for
the payment of all expected obligations, including surplus requirements,
under  the  municipal cooperative health benefit plan for a twelve-month
period, taking into account the plan's expected coverage and experience;
(B) a statement of the costs incorporated in such  premium  equivalent
rates,   including   an   itemization   of   the   amounts  for  claims,
administration, stop-loss insurance, reserves, surplus adjustments,  and
other   expenses   associated   with  the  operation  of  the  municipal
cooperative health benefit plan for the same twelve-month period;
(C) the expected number of employees, retirees, and dependents covered
under the municipal cooperative health benefit plan;
(D)  claims handling and dispute resolution procedures and timeframes,
including the manner in which claim denials can be appealed;
(E) method of selecting  service  providers,  including  any  contract
administrator; and
(F) current and projected financial statements, including statement of
assets,  liabilities  and  surplus,  statement of operations (income and
expenses), and cash flow statement; and
(9) such other information as may be required by the superintendent.
(c)  The  superintendent  shall  have  the  powers  to  conduct   such
investigation  as  the  superintendent may deem necessary and to examine
under oath any person interested in  or  connected  with  the  municipal
cooperative health benefit plan.