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This entry was published on 2014-09-22
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SECTION 4703
Application for certificate of authority
Insurance (ISC) CHAPTER 28, ARTICLE 47
§ 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.