2023 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.