reglab/statecodes huggingface dataset:
2023 New York Laws › ISC - Insurance › Article 45 - Fraternal Benefit Societies › 4530 - Optional Investment Authority.

§  4530.  Optional  Investment  Authority.  (a)  An authorized society
meeting the requirements set forth in  this  section  is  authorized  to
invest  its  funds  in, or otherwise acquire, or loan upon, the types of
investments specified in sections one thousand  four  hundred  two,  one
thousand  four  hundred  three,  one  thousand  four  hundred  five, one
thousand four hundred six, one  thousand  four  hundred  ten,  and  four
thousand  two  hundred forty of this chapter, subject to the limitations
contained therein. The provisions of section one thousand  four  hundred
four  of  this  chapter shall not have any application to investments of
such societies, except to the  extent  provided  in  paragraph  four  of
subsection (b) of section one thousand four hundred two of this chapter.
(b)  In  addition to other requirements of this article, an authorized
society investing pursuant to this  section  shall  meet  the  following
requirements:
(1)  Prior  to  investing  pursuant to this section, the society shall
submit notice to the superintendent that the board of directors  of  the
society  has  approved  investment pursuant to this section and that the
society meets the requirements of this section  and  intends  to  invest
hereunder;
(2)  The  society  shall:  (A) have been in continuous operation for a
minimum of five years; and (B) have total admitted assets  of  at  least
two  billion  dollars  for  a  period of five continuous years as of the
immediately preceding calendar year; and
(3) For each calendar year during which this section  applies  to  the
society,  the  society  shall  have,  as  of  the end of the immediately
preceding calendar year:
(A) had a risk based capital level of at least  six  times  authorized
control  level  RBC as defined by the provisions of section one thousand
three hundred twenty-two of this chapter; and
(B)  maintained  a  minimum  claims-paying,  financial   strength   or
equivalent  rating  from  at least one nationally recognized statistical
rating organization in one of the organization's  three  highest  rating
categories  for the time period during which this section applies to the
society provided that the rating shall not  depend  on  a  guarantee  or
other  credit enhancement from another entity; and shall not be modified
or  otherwise  qualified  to  show  dependence  of  the  rating  on  the
performance or a contractual obligation of, or the society's affiliation
with, another society.
(c)  Whenever  a  society  fails to meet the requirements set forth in
this section, the superintendent may, in his or her discretion, prohibit
or limit the  society  from  engaging  in  new  investments  under  this
section.
2023 New York Laws › ISC - Insurance › Article 46 - Retirement Systems › 4601 - Definitions.

§ 4601. Definitions. In this article:
(a) "Employees"  means  the  employees,  officers,  and  agents of any
person, firm or corporation  or  of  one  or  more  corporations  having
business interests in common.
(b) "Employer"  means  the  person,  firm,  corporation or one or more
corporations having business  interests  in  common,  and  includes  any
organization of such employers.
(c) "Retirement  system" or "system" means a non-profit corporation or
trust formed for the purpose of providing pension benefits.
(d) "Pension benefits" means benefits provided by a retirement  system
for members retiring by reason of age or length of service, or both, and
benefits  permitted  by  section four thousand six hundred three of this
article.
2023 New York Laws › ISC - Insurance › Article 46 - Retirement Systems › 4602 - Creation of Retirement Systems.

§  4602.  Creation  of  retirement  systems.  (a)  The  employees,  an
employer, or the employees and employer jointly, may create a retirement
system by filing in the office of the superintendent  a  declaration  of
their  intention  to  do  so,  in a form approved by the superintendent,
subscribed and affirmed as true under the penalties of  perjury  by  two
provisional  trustees  or  officers of such system, and an authenticated
copy of the constitution, by-laws or declaration  of  trust  adopted  to
regulate the affairs of the system.
(b)  Upon  such  filing  the superintendent may, if satisfied that the
rates of contribution are adequate and that the  plan  of  operation  is
sound  and  equitable,  issue  a  license,  subject to the provisions of
section one thousand one hundred two of this  chapter,  authorizing  the
retirement system to do the business described in the plan.
(c)  A  system shall have trustees who shall choose officers or agents
to carry on the business of the system. The by-laws  or  declaration  of
trust  of  such  a  system  shall  prescribe the manner in which and the
officers or agents by whom the system may be conducted and the manner in
which its funds shall be collected and disbursed.
(d) The funds and investments of a system shall be held  independently
of  the  funds  and investments of the employer and of any other person.
The manner of investment of the funds of a system shall  be  limited  in
every  respect  as in the case of the funds of a domestic life insurance
company, except  that  investments  shall  be  made  under  section  one
thousand four hundred four not section one thousand four hundred five of
this  chapter  and  shall  be  subject  to the provisions of section one
thousand four hundred four of this  chapter  that  relate  specially  to
retirement systems.
(e)  A  system  shall not issue or deliver any certificate or contract
providing for or promising to pay any benefit until a copy of  its  form
has  been  filed  with  the  superintendent  and  approved  by him. Such
certificate or contract shall conform to the provisions of this  article
and,  insofar  as  practicable,  to the other provisions of this chapter
applicable to similar policies or contracts.
2023 New York Laws › ISC - Insurance › Article 46 - Retirement Systems › 4603 - Benefits.

§  4603.  Benefits.  (a)  A  system  providing  retirement benefits by
agreement with an employer may also provide in the  same  agreement  for
withdrawal equities and benefits on account of disability or death.
(b)  A system may provide pension benefits by entering into agreements
with an employer or group of employers having a common  retirement  plan
which has been approved by the superintendent to receive funds which are
to  be  accumulated  at  interest  and, subject to the conditions agreed
upon, to apply the accumulated funds to provide pension benefits for the
employees of the  employer  or  group  of  employers  as  each  employee
retires.
(c)  No  agreement  shall be entered into with an employer or group of
employers having less than twenty-five employees who  are  eligible  for
retirement benefits under the agreement.
(d)  The accumulation of any funds contributed by an employee shall be
used for his exclusive benefit.
2023 New York Laws › ISC - Insurance › Article 46 - Retirement Systems › 4604 - Contributions.

§  4604.  Contributions.  (a)  The  participating  employees,  or  the
employer, or both may contribute to the funds  of  the  system  and  the
rates  of  contribution shall be fixed by the trustees upon the basis of
actuarial recommendations and shall be adequate to support the  benefits
granted.
(b)  The  trustees  may,  with  the  approval  of  the superintendent,
increase or decrease the rates of contribution whenever such  action  is
deemed  by  them  necessary  to  preserve the solvency and equity of the
system.
2023 New York Laws › ISC - Insurance › Article 46 - Retirement Systems › 4605 - Reinsurance.

§  4605. Reinsurance. (a) All or any part of the pension benefits of a
system may be reinsured in an insurance  company  authorized  to  insure
such  risks  in  this  state,  as  may be provided for in the by-laws or
declaration of trust of the retirement system.
(b) The reinsurance contract may be terminated  by  agreement  between
the  reinsurer  and  the ceding retirement system or a successor and the
assets supporting such agreement may be transferred to  such  system  or
its  successor  in  one sum or over a period of years in accordance with
terms and conditions approved by the superintendent. In such event,  the
funds  transferred  in  one  sum  or  the  present  value  of sums to be
transferred over a period of years shall become  an  admitted  asset  of
such system or its successor.
2023 New York Laws › ISC - Insurance › Article 46 - Retirement Systems › 4606 - Reserves.

§  4606.  Reserves.  (a) A system shall, except to the extent that its
benefits are reinsured by an insurance company  authorized  to  transact
such business in this state, create and maintain reserves, calculated to
be  adequate  to  cover  the  liabilities on account of benefits payable
under its contracts, by-laws, or declaration of trust.
(b)  The  calculation  shall  be  made  on  the  basis  of  mortality,
disability, and other experience tables based on reliable experience for
such or a similar group of employees and approved by the superintendent,
and of interest at a rate which is approved by the superintendent and is
not  in  excess of the maximum rate permitted to domestic life insurance
companies under section four thousand  two  hundred  seventeen  of  this
chapter  for  the  valuation  of  group annuities, for all participating
employees in the system upon application by the  system  and  a  showing
that  such  rate  can be supported by the income from the investments of
the system.
(c) The reserves required in respect of service rendered  or  benefits
granted  prior  to  the  date of organization or creation of such system
under this chapter may be accumulated on a basis calculated to produce a
balance between the actuarial present value of the  assets  and  of  the
liabilities  of the system within a period of not exceeding thirty years
from the date of the incorporation or creation thereunder.
2023 New York Laws › ISC - Insurance › Article 46 - Retirement Systems › 4607 - Exemption From Taxation; Trusts; Higher Education Loans.

§  4607.  Exemption from taxation; trusts; higher education loans. (a)
The property of a system, the portion of wages or salary of an  employee
deducted  or  to  be  deducted,  the  right  of an employee to a pension
benefit, and all his rights in the funds of the system, shall be  exempt
from  taxation  and from the operation of any law relating to bankruptcy
or insolvency, except as provided in section four thousand  six  hundred
eight  of  this  article  and subject to the provisions of section three
thousand two hundred twelve of this chapter.
(b) No trust created pursuant to this article shall be deemed  invalid
as violating any existing laws against perpetuities or suspension of the
power  of  alienation  of title to property; and the income arising from
any property, real or personal, held in such trust may be  permitted  to
accumulate  until  the  fund  shall  be sufficient in the opinion of its
trustee or trustees to accomplish the purposes of such trust.
(c) Any system may lend money to any of its participating employees or
their children, who are attending or  planning  to  attend  college,  to
assist  them  in  meeting their expenses of higher education, where such
loans  are  guaranteed  by  the  New  York  higher  education   services
corporation in accordance with the provisions of article fourteen of the
education  law.  In  such cases no further security for the repayment of
such loans shall be required of the borrowers by such system.
2023 New York Laws › ISC - Insurance › Article 46 - Retirement Systems › 4608 - Application.

§  4608. Application. (a) Every system organized or created under this
chapter  shall  be  subject  to  the  provisions  of  this  article,  to
subsection  (g) of section one thousand one hundred two of this chapter,
to the appropriate provisions of articles one, three and seventy-four of
this chapter, and to articles thirteen and  fourteen  of  this  chapter,
insofar  as  applicable to the assets and investments of a domestic life
insurance company, except that the provisions of  section  one  thousand
four  hundred  four (and the provisions therein that relate specially to
retirement systems) shall be applicable instead  of  the  provisions  of
section one thousand four hundred five of this chapter.
(b) Article seventeen of this chapter is applicable to any such system
for  the  purpose of investing in the stock of a domestic life insurance
company organized on a restricted plan pursuant  to  the  provisions  of
subsection  (b) of section four thousand two hundred two of this chapter
and for investing in or otherwise acquiring subsidiaries  of  the  types
described in section one thousand seven hundred four of this chapter.
(c)  Section  four thousand two hundred forty of this chapter shall be
applicable to any such system  in  which  the  total  present  value  of
benefits  provided by the employer for members in active service exceeds
fifty million dollars, subject to such modifications in the  application
of the provisions of such section as the superintendent may prescribe by
rules  and  regulations  not  inconsistent  with  the provisions of this
chapter, as may be  appropriate  to  carry  out  the  purposes  of  this
article.
2023 New York Laws › ISC - Insurance › Article 47 - Municipal Cooperative Health Benefit Plans › 4701 - Legislative Findings.

§  4701.  Legislative  findings.  (a)  Cooperative health risk-sharing
agreements allow public entities to: share, in whole or part, the  costs
of   self-funding  employee  health  benefit  plans;  provide  municipal
corporations, school  districts  and  other  public  employers  with  an
alternative  approach  to  stabilize  health claim costs; lower per unit
administration  costs;  and  enhance  negotiating  power   with   health
providers by spreading such costs among a larger pool of risks.
(b)  Appropriate  safeguards  are  necessary  to help keep self-funded
municipal cooperative health benefits plans from exposing municipalities
and  their  taxpayers  to  unpredictable  and  potentially  catastrophic
liabilities.  Minimum standards regarding benefits and participation can
better assure that  self-funded  municipal  cooperative  health  benefit
plans  will  continue  to  act  responsibly  and  provide  coverage  for
high-cost conditions and high-cost individuals.
(c) It is  the  policy  of  this  state  to  expand  the  alternatives
available to public employers by permitting the development of municipal
cooperative  health  benefit plans while, at the same time, establishing
appropriate standards designed to promote  fair  competition  and  sound
operation of such plans on an ongoing basis.
(d)  It  is the legislative intent that the superintendent implement a
workable system of authorization and regulation of municipal cooperative
health benefit plans in this state, in order to assure that  such  plans
are:
(1)  operated on an actuarially sound basis with appropriate financial
and other standards to protect plan participants and their beneficiaries
as well as local taxpayers; and
(2) not unduly disruptive of the regulated insurance market and public
health programs.
2023 New York Laws › ISC - Insurance › Article 47 - Municipal Cooperative Health Benefit Plans › 4707 - Stop-Loss Requirements.

§ 4707. Stop-loss requirements. (a) The governing board of a municipal
cooperative  health  benefit plan shall obtain and maintain on behalf of
the plan a stop-loss insurance policy  or  policies  delivered  in  this
state and issued by a licensed insurer, providing:
(1)  aggregate  stop-loss  coverage with an annual aggregate retention
amount or attachment point not  greater  than  one  hundred  twenty-five
percent  of the amount certified by a qualified actuary to represent the
expected claims of the plan for the current fiscal year; and
(2) specific stop-loss coverage with a specific  retention  amount  or
attachment  point  not greater than four percent of the amount certified
by a qualified actuary to represent the plan's expected claims  for  the
current fiscal year.
(b)  Upon  application  of the governing board, the superintendent may
waive the requirement for the stop-loss insurance, in whole or part,  or
modify  the maximum retention amounts or attachment points for stop-loss
insurance, provided that:
(1) the plan maintains reserves and surplus equal to or  greater  than
one hundred fifty percent of the amounts specified in paragraphs one and
five  of  subsection  (a)  of section four thousand seven hundred six of
this article; or
(2) the superintendent is satisfied that such waiver  or  modification
of  retention  amounts  or attachment points would not be detrimental to
the plan's solvency and stability, after  considering  such  factors  as
availability  and  affordability of stop-loss insurance, the plan's past
and expected experience,  plan  size,  reserves,  surplus,  and  premium
equivalent   rates,   and  the  contingent  liability  of  participating
municipal corporations.
(c) As an alternative to suspension or revocation pursuant to  section
four  thousand  seven hundred twelve of this article, the superintendent
may reduce the aggregate or  specific  stop-loss  retention  amounts  or
attachment  points  specified  in subsection (a) of this section for any
municipal  cooperative  health  benefit  plan  that  fails  to  maintain
required reserves and surplus.
2023 New York Laws › ISC - Insurance › Article 47 - Municipal Cooperative Health Benefit Plans › 4708 - Contingent Liability.

§  4708. Contingent liability. (a) The municipal cooperation agreement
and  the  plan  document  delivered  to  each  participating   municipal
corporation shall provide that every municipal corporation participating
in  the municipal cooperative health benefit plan shall be liable in the
event of an order issued pursuant to subsection (b) of this section  for
an  assessment,  in addition to the amount of premium equivalent paid or
payable.
(b) If the municipal cooperative health benefit  plan  does  not  have
admitted  assets,  as  defined  in  section  one  hundred  seven of this
chapter, at least equal to the aggregate of  its  liabilities,  reserves
and  minimum  surplus  required  by this article, the governing board of
such plan shall, within thirty days thereafter, order an assessment  for
the  amount that will provide sufficient funds to remove such impairment
and collect from each municipal corporation a pro  rata  share  of  such
assessed amount.
(c)  Every  municipal  corporation  that participated in the municipal
cooperative health benefit plan at any time during the  two-year  period
prior  to  the  issuing  of  an assessment order by the plan's governing
board shall, if notified of such assessment, pay its pro rata  share  of
such assessment within ninety days after the issuance of that assessment
order.
(d)  A  municipal corporation's pro rata share of any assessment shall
be determined by applying the ratio of the total assessment to the total
contributions or premium equivalents earned during the period covered by
the assessment on all municipal corporations subject  to  assessment  to
the  contribution  or  premium  equivalent  earned  during  such  period
attributable to such municipal corporation.
(e) The contingent liability of municipal corporations for  additional
premium  equivalents or assessments shall not be included as an asset in
the financial statements of the  municipal  cooperative  health  benefit
plan.
2023 New York Laws › ISC - Insurance › Article 47 - Municipal Cooperative Health Benefit Plans › 4709 - Plan Benefits and Disclosure.

§  4709.  Plan benefits and disclosure. (a) The governing board of the
municipal cooperative health benefit plan shall deliver or cause  to  be
delivered  the plan document to all participating municipal corporations
and  to  unions  which   are   the   exclusive   collective   bargaining
representatives  of  employees  covered by the plan and the summary plan
description to every employee  or  retiree  of  participating  municipal
corporations covered by the plan.
(b)  The summary plan description shall be subject to regulation as if
it were a health insurance subscriber  certificate,  provided  that  the
superintendent  may  modify  or suspend any provision of this chapter or
regulation  promulgated  thereunder  pertaining  to  scope  or  type  of
coverage, if the superintendent determines:
(1)  such  provision of this chapter or regulation to be inappropriate
for municipal cooperative health benefit plans;
(2) such modification or suspension  not  to  be  prejudicial  to  the
interests of covered employees, retirees or dependents; and
(3)   such  modification  or  suspension  not  to  be  destructive  of
competition.
(c) Conspicuously printed on the first page of the plan  document  and
summary plan description, in at least ten point bold-face type, shall be
the following statement:
"This  municipal  cooperative  health  benefit  plan is not a licensed
insurer. It operates under  a  more  limited  certificate  of  authority
granted   by   the   superintendent  of  financial  services.  Municipal
corporations participating in the municipal cooperative  health  benefit
plan are subject to contingent assessment liability."
2023 New York Laws › ISC - Insurance › Article 47 - Municipal Cooperative Health Benefit Plans › 4710 - Additional Filing Requirements and Annual Report.

§  4710.  Additional  filing  requirements  and annual report. (a) The
governing board of the municipal cooperative health benefit plan shall:
(1) file  for  approval  with  the  superintendent  a  description  of
material  changes  in  any  information  provided in the application for
certificate of authority in  the  form  and  manner  prescribed  by  the
superintendent;
(2)  annually,  not later than one hundred twenty days after the close
of the plan year, file a report  with  the  superintendent  showing  the
financial  condition  and  affairs  of  the  plan  (including  an annual
independent financial audit statement and independent actuarial opinion)
as of the end of the preceding plan year, in  such  form  and  providing
such  other  information  as  the  superintendent  may  prescribe and in
compliance with section three hundred seven of this chapter; and
(3) file a report each quarter with the superintendent describing  the
plan's  current  financial  status and providing such information as the
superintendent may prescribe.
(b) The plan's annual report  shall  be  furnished  to  all  municipal
corporations and to unions which are the exclusive collective bargaining
representatives of employees covered by the municipal cooperative health
benefit  plan and shall be made available for inspection by any employee
or retiree covered under the plan.
2023 New York Laws › ISC - Insurance › Article 47 - Municipal Cooperative Health Benefit Plans › 4711 - Examinations.

§  4711.  Examinations. (a) The superintendent may examine the affairs
of a municipal cooperative  health  benefit  plan  as  often  as  deemed
necessary,  but not less than once in every three years, except that the
superintendent may extend the three-year interval to no more  than  five
years  upon determining that the three-year requirement is not necessary
to safeguard the interests of the public or covered persons.
(b) In connection  with  such  examinations,  the  superintendent  may
exercise  the  powers  set  forth  in  sections three hundred six, three
hundred eight, three  hundred  ten,  three  hundred  eleven,  and  three
hundred twelve of this chapter and subsection (f) of section two hundred
six  and  sections  three  hundred  five  and  three  hundred six of the
financial services law, and may also  require  special  reports  from  a
municipal  cooperative health benefit plan as specified in section three
hundred eight of this chapter.
(c) The governing board of every municipal cooperative health  benefit
plan  shall  be  responsible for the maintenance of accurate records and
books of account in regard to the plan.
2023 New York Laws › ISC - Insurance › Article 47 - Municipal Cooperative Health Benefit Plans › 4712 - Suspension or Revocation of Certificate of Authority.

§  4712. Suspension or revocation of certificate of authority. (a) The
superintendent may suspend or revoke a certificate of  authority  issued
to  a  municipal  cooperative  health  benefit  plan under the following
circumstances:
(1) for any cause that would be a  basis  for  denial  of  an  initial
application  for  such  a  certificate, provided that the superintendent
shall not suspend or revoke such certificate solely due to the  size  or
composition  of  the  plan  unless the plan ceases to cover a minimum of
three hundred fifty employees and retirees; or
(2) failure to maintain the reserves and surplus required  by  section
four  thousand  seven  hundred  six  of  this article, provided that the
superintendent shall not suspend or revoke such certificate if the  plan
has implemented a remediation plan acceptable to the superintendent; or
(3)  the  superintendent  finds  that the municipal cooperative health
benefit plan has refused to produce its accounts, records, and files for
examination or any member  of  the  governing  board  of  the  municipal
cooperative  health  benefit  plan  has  refused  to  cooperate  or give
information with respect to the affairs of the plan or  to  perform  any
other  legal obligation relating to such an examination when required by
the superintendent.
(b) In the case of  suspension  or  revocation  of  a  certificate  of
authority,  the superintendent shall send a copy of such decision to the
governing board of the municipal  cooperative  health  benefit  plan  by
certified  mail at the plan's address. Upon the request of the governing
board, or any party that  would  be  prejudiced  by  the  suspension  or
revocation,   filed   within   sixty   days   of   the  mailing  of  the
superintendent's decision, the superintendent shall schedule  a  hearing
on  such  decision  by  written  notice,  sent  by certified mail to the
governing board or party requesting the hearing. Such notice  shall  set
forth  a  specific  date,  time  and  place for the hearing, which shall
commence within sixty days of the mailing of the notice.
(c) Any certificate of  authority  suspended  or  revoked  under  this
section  shall  be  surrendered  to  the  superintendent, and the plan's
governing board shall notify all participating municipal corporations of
that decision  in  such  form  and  manner  as  the  superintendent  may
prescribe,  not  later  than  ten  days  after  receipt of notice of the
superintendent's decision requiring suspension or revocation.
(d) The superintendent shall publish all final decisions to suspend or
revoke the certificate of authority in regard to a municipal cooperative
health benefit plan.
2023 New York Laws › ISC - Insurance › Article 47 - Municipal Cooperative Health Benefit Plans › 4713 - Plan Dissolution.

§ 4713. Plan dissolution. (a) In any case in which the governing board
of  a municipal cooperative health benefit plan determines that there is
reason to believe that the plan  will  terminate,  the  governing  board
shall   so   inform  the  superintendent  and  submit  a  plan  for  the
superintendent's approval for  winding  up  the  plan's  affairs  in  an
orderly  manner designed to result in timely payment of all benefits, in
such form and manner as the superintendent may prescribe.
(b) No part of any funds of the municipal cooperative  health  benefit
plan  shall  be  subject  to  the  claims  of  general  creditors of any
participating municipal corporation until all plan  benefits  and  other
plan obligations have been satisfied.
(c)  The  superintendent  may  maintain  a  proceeding  under  article
seventy-four of this chapter to rehabilitate or liquidate  the  business
of   a  municipal  cooperative  health  benefit  plan,  which  shall  be
considered an insurer for such purpose under section seven thousand four
hundred one of this chapter.
2023 New York Laws › ISC - Insurance › Article 47 - Municipal Cooperative Health Benefit Plans › 4714 - Transition.

§  4714.  Transition.  For  municipal cooperative health benefit plans
that provided medical,  surgical  or  hospital  services  on  or  before
January  first,  nineteen  hundred  ninety-three pursuant to a municipal
cooperation agreement authorized under article  five-G  of  the  general
municipal  law,  the  reserve  and  surplus requirements in section four
thousand seven hundred six of this article  may  be  phased  in  over  a
period of up to five plan years, provided that:
(a)  the  amount  for  the  reserve  described  in  paragraph  one  of
subsection (a) of section  four  thousand  seven  hundred  six  of  this
article:
(1)  at  the end of the first plan year on or after the effective date
of this article shall not  be  less  than  twelve  percent  of  expected
incurred claims and expenses thereon for such plan year; and
(2) at the end of each subsequent plan year during the phase-in period
shall  not  be  less  than  the actual percentage amount in the previous
year, plus an  amount  equal  to  the  difference  between  such  actual
percentage  amount  and  the  percentage amount otherwise required under
section four thousand seven hundred six of this article, divided by  the
number of years remaining in the phase-in period;
(b) the amount of surplus:
(1)  at  the end of the first plan year on or after the effective date
of this article shall not be less than two  percent  of  the  annualized
earned premium equivalents during such plan year; and
(2) at the end of each subsequent plan year shall not be less than the
actual percentage amount in the previous plan year, plus an amount equal
to  the  difference  between  such  actual  percentage  amount  and  the
percentage otherwise required under section four thousand seven  hundred
six  of  this  article,  divided by the number of years remaining in the
phase-in period; and
(c) the superintendent may reduce the aggregate or specific  stop-loss
retention  amounts  or  attachment  points,  referred to in section four
thousand seven hundred seven of this article, during the phase-in period
for any municipal cooperative health  benefit  plan  which  consists  of
fewer  than  five  municipal  corporations or which covers less than two
thousand employees and retirees.
2023 New York Laws › ISC - Insurance › Article 48 - Managed Care Health Insurance Contracts › 4801 - Application.

§ 4801. Application. The provisions of this article shall apply to all
managed  care  products,  as  defined in subsection (c) of this section,
which are delivered or issued for delivery in  this  state  by  insurers
licensed  under  this  chapter;  provided,  however,  that  none  of the
provisions of  this  article  shall  apply  to  any  health  maintenance
organization lines of business of such insurers or to health maintenance
organizations  certified  under  article forty-four of the public health
law or licensed under article forty-three of  this  chapter,  which  are
subject  to  the  provisions  of article forty-four of the public health
law. For purposes of this article:
(a) an "insured" shall mean a person  covered  under  a  managed  care
health insurance contract.
(b)  an  "insurer"  shall mean an insurance company subject to article
thirty-two  of  this  chapter,  or  a  corporation  subject  to  article
forty-three of this chapter.
(c)  a  "managed  care  health  insurance  contract"  or "managed care
product" shall mean a contract which requires that all medical or  other
health  care  services  covered under the contract, other than emergency
care services, be provided  by,  or  pursuant  to  a  referral  from,  a
designated  health  care  provider chosen by the insured (i.e. a primary
care gatekeeper), and that services provided pursuant to such a referral
be rendered by a health care provider  participating  in  the  insurer's
managed  care  provider  network.  In  addition,  in  the case of (i) an
individual health insurance contract, or (ii) a group  health  insurance
contract   covering  no  more  than  three  hundred  lives,  imposing  a
coinsurance obligation of more than twenty-five  percent  upon  services
received  outside  of the insurer's provider network, and which has been
sold to five or more groups, a managed care product shall  also  mean  a
contract  which  requires that all medical or other health care services
covered under the contract,  other  than  emergency  care  services,  be
provided  by,  or  pursuant to a referral from, a designated health care
provider chosen by the insured (i.e. a  primary  care  gatekeeper),  and
that  services  provided  pursuant  to  such a referral be rendered by a
health  care  provider  participating  in  the  insurer's  managed  care
provider network, in order for the insured to be entitled to the maximum
reimbursement under the contract.
(d)  "in-network  benefits"  shall  mean benefits covered and received
under a managed care product from a health care  provider  participating
in  the  insurer's  managed care provider network pursuant to a referral
from the insured's participating primary care gatekeeper.
2023 New York Laws › ISC - Insurance › Article 48 - Managed Care Health Insurance Contracts › 4806 - Health Care Facility Applications.

§  4806. Health care facility applications. (a) An insurer that offers
a managed care product shall, upon request, make available and  disclose
to  facilities  written application procedures and minimum qualification
requirements that a facility must meet in order to be considered by  the
insurer  for  participation  in  the  in-network benefits portion of the
insurer's network for  the  managed  care  product.  The  insurer  shall
consult  with  appropriately  qualified  facilities  in  developing  its
qualification requirements for participation in the in-network  benefits
portion  of  the  insurer's  network  for  the  managed care product. An
insurer  shall  complete  review  of  the  facility's   application   to
participate  in  the  in-network  portion  of the insurer's network and,
within sixty days of receiving a  facility's  completed  application  to
participate  in  the insurer's network, shall notify the facility as to:
(1) whether the facility is credentialed; or (2) whether additional time
is necessary to make a determination because of a  failure  of  a  third
party  to  provide  necessary  documentation.  In  such  instances where
additional  time  is  necessary  because  of   a   lack   of   necessary
documentation,  an  insurer  shall  make  every  effort  to  obtain such
information as soon as possible and shall  make  a  final  determination
within twenty-one days of receiving the necessary documentation.
(b)  For  the purposes of this section, "facility" shall mean a health
care provider that is licensed or certified pursuant  to  article  five,
twenty-eight,  thirty-six,  forty,  forty-four,  or  forty-seven  of the
public health law or article sixteen, nineteen, thirty-one,  thirty-two,
or thirty-six of the mental hygiene law.
2023 New York Laws › ISC - Insurance › Article 49 - Utilization Review and External Appeal › Title 1 - Registration of Agents and Review Process › 4906 - Waiver.

§  4906.  Waiver.  (a)  Any  agreement which purports to waive, limit,
disclaim, or in any way diminish the rights set forth in  this  article,
except as provided pursuant to section four thousand nine hundred ten of
this article shall be void as contrary to public policy.
(b)  Notwithstanding  subsection  (a)  of this section, in lieu of the
external appeal process as set forth in this article, a health care plan
and a facility licensed pursuant to article twenty-eight of  the  public
health  law  may agree to an alternative dispute resolution mechanism to
resolve disputes otherwise subject to this article.
2023 New York Laws › ISC - Insurance › Article 49 - Utilization Review and External Appeal › Title 1 - Registration of Agents and Review Process › 4907 - Rights and Remedies.

§ 4907. Rights and remedies. The rights and remedies conferred in this
  article  upon insureds and health care providers shall be cumulative and
  in addition to and not in lieu of any other rights or remedies available
  under law.
2023 New York Laws › ISC - Insurance › Article 49 - Utilization Review and External Appeal › Title 1 - Registration of Agents and Review Process › 4908 - Applicability to Erisa Plans.

§  4908.  Applicability to ERISA Plans. Notwithstanding the foregoing,
  the provisions of this article shall not apply to any utilization review
  conducted by, or on behalf of, a self-insured employee  welfare  benefit
  plan, as defined in the employee retirement income security act of 1974,
  as amended.
2023 New York Laws › ISC - Insurance › Article 49 - Utilization Review and External Appeal › Title 2 - Right to External Appeal › 4911 - Powers of the Superintendent.

§  4911.  Powers  of  the superintendent. (a) The superintendent shall
have the power to grant and revoke  certifications  of  external  appeal
agents  to  conduct external appeals requested pursuant to paragraph one
or two of subsection (b) of section four thousand nine  hundred  ten  of
this title or pursuant to both such paragraphs.
(b)  If,  after  reviewing  the application authorized by section four
thousand nine hundred  twelve  of  this  title,  the  superintendent  is
satisfied that the applicant meets the requirements of this section, the
superintendent shall issue a certificate to the applicant. A certificate
issued  under  this section shall be valid for a period of not more than
two years.
(c) In order  to  be  re-certified,  an  external  appeal  agent  must
demonstrate   to   the   superintendent   on  forms  prescribed  by  the
superintendent that  it  continues  to  meet  all  applicable  standards
required  by  this  title.  Re-certification under this section shall be
valid for a period of not more than two years.
2023 New York Laws › ISC - Insurance › Article 49 - Utilization Review and External Appeal › Title 2 - Right to External Appeal › 4913 - Conflict of Interest.

§ 4913. Conflict of interest. (a) No external appeal agent or officer,
director,  or  management  employee  thereof;  or clinical peer reviewer
employed or engaged thereby to conduct any external appeal  pursuant  to
this  title,  shall have any material professional affiliation, material
familial  affiliation,  material   financial   affiliation,   or   other
affiliation   prescribed   pursuant  to  regulation,  with  any  of  the
following:
(1) the health care plan;
(2) any officer, director, or management employee of the  health  care
plan;
(3)  any  health care provider, physician's medical group, independent
practice association, or provider of pharmaceutical products or services
or durable medical equipment, proposing to provide or supply the  health
service;
(4) the facility at which the health service would be provided;
(5)  the  developer  or  manufacturer  of the principal health service
which is the subject of the appeal; or
(6) the insured whose health  care  service  is  the  subject  of  the
appeal, or the insured's designee.
(b) Notwithstanding subsection (a) of this section, the superintendent
shall  promulgate regulations to minimize any conflict of interest where
such conflict may be unavoidable.
2023 New York Laws › ISC - Insurance › Article 49 - Utilization Review and External Appeal › Title 2 - Right to External Appeal › 4915 - Prohibited Practices.

§ 4915. Prohibited practices. An external appeal agent shall not, with
respect to external appeal activities, permit or provide compensation or
anything of value to its employees, agents, or contractors based on:
(a)  either a percentage of the amount by which a claim is reduced for
payment or the number of claims or the cost of services  for  which  the
person has denied authorization or payment; or
(b)  any  other  method  that  encourages  the upholding of an adverse
determination.
2023 New York Laws › ISC - Insurance › Article 49 - Utilization Review and External Appeal › Title 2 - Right to External Appeal › 4916 - Oversight and Surveillance of the External Appeal Process.

§ 4916. Oversight and surveillance of the external appeal process. (a)
The superintendent shall have the power to:
(1) review the activities of the health care plans and external appeal
agents  pursuant to this title, including the extent to which such plans
and agents adhere to the standards and time frames required pursuant  to
this title;
(2)  investigate  complaints  by  insureds  regarding requests for and
processing of external appeals; and
(3) conduct random audits of health care  plans  and  external  appeal
agents to determine compliance with the provisions of this title.
(b) Each health care plan and external appeal agent shall annually, in
such  form  as  the  superintendent  shall require, report the number of
external appeals requested by insureds and  the  outcomes  of  any  such
external appeals.
(c)  The  superintendent  shall annually report, by plan and by agent,
such information to the governor and the legislature, provided  that  no
such  information  shall  be  included  which  would otherwise be deemed
confidential information within the meaning of this chapter.
2023 New York Laws › ISC - Insurance › Article 49 - Utilization Review and External Appeal › Title 2 - Right to External Appeal › 4917 - Hold Harmless.

§  4917.  Hold harmless. A health care provider requesting an external
  appeal of a concurrent adverse determination, including when the  health
  care  provider  requests  an  external appeal as the insured's designee,
  shall not pursue reimbursement from the insured for services  determined
  not  medically necessary by the external appeal agent, except to collect
  a copayment, coinsurance or deductible.
2023 New York Laws › ISC - Insurance › Article 51 - Comprehensive Motor Vehicle Insurance Reparations › 5104 - Causes of Action for Personal Injury.

§  5104. Causes of action for personal injury. (a) Notwithstanding any
other law, in any action by or on behalf of  a  covered  person  against
another  covered  person for personal injuries arising out of negligence
in the use or operation of a motor vehicle in this state, there shall be
no right of recovery for non-economic loss, except  in  the  case  of  a
serious  injury,  or  for  basic  economic  loss. The owner, operator or
occupant of a motorcycle which has  in  effect  the  financial  security
required  by  article  six  or  eight of the vehicle and traffic law, or
which is referred  to  in  subdivision  two  of  section  three  hundred
twenty-one  of  such  law,  shall  not  be subject to an action by or on
behalf of a covered person for recovery for non-economic loss, except in
the case of a serious injury, or for basic economic loss.
(b) In any action by or on behalf of a covered person, against a  non-
covered  person,  where damages for personal injuries arising out of the
use or operation of a motor vehicle or a motorcycle may be recovered, an
insurer which paid or is liable for first party benefits on  account  of
such  injuries has a lien against any recovery to the extent of benefits
paid or payable by it to the covered  person.  No  such  action  may  be
compromised by the covered person except with the written consent of the
insurer,  or with the approval of the court, or where the amount of such
settlement exceeds fifty thousand dollars. The failure of such person to
commence such action within two years after accrual gives the insurer  a
cause  of  action for the amount of first party benefits paid or payable
against any person who may be liable  to  the  covered  person  for  his
personal injuries. The insurer's cause of action shall be in addition to
the  cause  of  action  of  the covered person except that in any action
subsequently commenced by the covered  person  for  such  injuries,  the
amount of his basic economic loss shall not be recoverable.
(c)  Where there is no right of recovery for basic economic loss, such
loss may nevertheless be pleaded and proved to the  extent  that  it  is
relevant to the proof of non-economic loss.
2023 New York Laws › ISC - Insurance › Article 51 - Comprehensive Motor Vehicle Insurance Reparations › 5105 - Settlement Between Insurers.

§  5105.  Settlement  between insurers. (a) Any insurer liable for the
payment of first party benefits to or on behalf of a covered person  and
any  compensation  provider  paying  benefits  in  lieu  of  first party
benefits which another insurer  would  otherwise  be  obligated  to  pay
pursuant to subsection (a) of section five thousand one hundred three of
this  article  or  section  five thousand two hundred twenty-one of this
chapter has the right to recover the amount paid from the insurer of any
other covered person to the extent that such other covered person  would
have been liable, but for the provisions of this article, to pay damages
in an action at law. In any case, the right to recover exists only if at
least  one  of  the  motor vehicles involved is a motor vehicle weighing
more than six thousand five  hundred  pounds  unloaded  or  is  a  motor
vehicle  used  principally for the transportation of persons or property
for hire. However, in  the  case  of  occupants  of  a  bus  other  than
operators, owners, and employees of the owner or operator of the bus, an
insurer  which,  pursuant  to paragraph one of subsection (a) of section
five thousand one hundred three of this article, provides  coverage  for
first  party  benefits for such occupants under a policy providing first
party benefits to the injured person and members of  his  household  for
loss  arising  out  of  the  use  or  operation  of  any vehicle of such
household, shall have no right to recover the amount  of  such  benefits
from the insurer of such bus.
(b) The sole remedy of any insurer or compensation provider to recover
on  a  claim  arising  pursuant  to  subsection (a) hereof, shall be the
submission of the  controversy  to  mandatory  arbitration  pursuant  to
procedures   promulgated  or  approved  by  the  superintendent.    Such
procedures shall also  be  utilized  to  resolve  all  disputes  arising
between  insurers  concerning  their  responsibility  for the payment of
first party benefits.
(c) The liability of an insurer imposed  by  this  section  shall  not
affect  or  diminish  its  obligations under any policy of bodily injury
liability insurance.
2023 New York Laws › ISC - Insurance › Article 51 - Comprehensive Motor Vehicle Insurance Reparations › 5107 - Coverage for Non-Resident Motorists.

§  5107.  Coverage  for  non-resident  motorists.  (a)  Every  insurer
authorized to  transact  or  transacting  business  in  this  state,  or
controlling  or controlled by or under common control by or with such an
insurer,  which  sells  a  policy  providing  motor  vehicle   liability
insurance  coverage  or  any  similar  coverage in any state or Canadian
province, shall include in each such  policy  coverage  to  satisfy  the
financial  security  requirements of article six or eight of the vehicle
and traffic law and to provide for the payment of first  party  benefits
pursuant to subsection (a) of section five thousand one hundred three of
this  article  when  a  motor  vehicle covered by such policy is used or
operated in this state.
(b) Every policy described in subsection (a) hereof shall be construed
as having the coverage  required  by  subsection  (a)  of  section  five
thousand one hundred three of this article.