N.Y. ISC Law § 4703

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