N.Y. General Municipal Law § 92-a: Medical, surgical and hospital services or insurance for officers, employees and retired officers and employees of public corporations an...

§ 92-a. Medical, surgical and hospital services or insurance for

officers, employees and retired officers and employees of public

corporations and their families. 1. As used in this section, the term

"public corporation" shall mean a municipal corporation, a district

corporation, a school district, a consolidated health district and a

county or town special district or a joint special district, governed by

a separate board of commissioners. Officers, employees and retired

officers and employees of a county or town special district which is not

governed by a separate board of commissioners shall be deemed to be

county or town officers and employees, or retired officers and

employees, respectively.

1-a. As used in this section the term "retired officer" shall include

any former school board member with twenty years or more service in such

position. The total cost of participation by such former school board

members and their families shall be borne by such former members.

2. A public corporation may contract with a non-profit membership

corporation, organized under article forty-three of the insurance law

and approved by the superintendent of financial services and the state

board of social welfare, or with any insurance company authorized to do

business in this state for the purpose of furnishing medical and

surgical services and hospital service as defined in such article

forty-three, or medical and surgical and hospital insurance to persons

who contract with such non-profit membership corporation or insurance

company, or who subscribe to a plan or plans, as hereinafter provided.

Any such contract entered into by a public corporation shall permit any

officer or employee or group of officers or employees of an agency or

department of the public corporation voluntarily to subscribe to a plan

or plans providing for medical and surgical and hospital insurance for,

or medical and surgical services and hospital service to, such officers

or employees and their families. Any such contract entered into by a

public corporation may, if authorized by the governing board or body and

subject to such conditions, limitations and eligibility requirements as

may be fixed by such board or body, permit any retired officers and

employees or group of retired officers and employees of an agency or

department of the public corporation voluntarily to subscribe to such a

plan or plans to provide such insurance for or service to themselves and

their families. The comptroller or other disbursing officer of the

public corporation, or of any fund out of which officers or employees of

such public corporation are paid, is authorized to deduct from the wages

or salary of such contracting or subscribing officer or employee, with

his prior consent, in writing, the sums required to be paid by such

officer or employee to such non-profit membership corporation or

insurance company. Such public corporation, if such contract or plan

provides that the employer shall contribute a share of the cost of such

medical and surgical services and hospital service, or medical and

surgical and hospital insurance, for its officers and employees or

retired officers and employees, is authorized to appropriate a sum

required to be paid under such contract by the public corporation as

employer. The sum to be paid by it under such contract, in the

discretion of such public corporation, may be any percentage of the

total cost including the whole thereof. Where the compensation of any

officer or employee whose position is covered by medical and surgical

services and hospital service or medical and surgical and hospital

insurance pursuant to this section is paid from a special or

administrative fund provided for by law, the contributions required to

be paid by the public corporation for such coverage shall be paid from

such special or administrative fund. The public corporation shall be

authorized to pay directly to such non-profit membership corporation or

to such insurance company, the total of such appropriation and of such

officer and employee deductions.

3. The authority conferred upon public corporations by this section

shall be in addition to and in no way a limitation upon the authority

conferred upon such public corporations to provide the same or similar

benefits for their officers and employees pursuant to article eleven of

the civil service law.

4. The provisions of this section shall apply to school board members,

provided however, that the total cost of participation by such school

board members and their families shall be borne by such members.

5. Any contract or contracts made pursuant to this section by a city

with a population of one million or more inhabitants and any plan or

plans effectuated by any such contract or contracts shall be

administered by the department of personnel or the office of municipal

labor relations of such city, or if there be no such department or

office therein, by a department, agency, or officer thereof designated

by the mayor of such city.

6. (a) Notwithstanding any general, special or local law to the

contrary, the governing board of a public corporation that, in lieu of

contracting pursuant to subdivision two of this section, self-funds

medical, surgical or hospital benefits, may enter into agreements with

duly qualified contract administrators or other service providers to

receive, investigate, make recommendations on, audit, approve or make

payment of claims for such benefits. Such agreements shall be entered

into pursuant to competitive bidding, or written request for proposals

in accordance with the procurement policies and procedures of the public

corporation adopted pursuant to section one hundred four-b of this

chapter.

(b) In order to authorize the payment of claims for benefits audited

and approved by a contract administrator or other service provider, an

agreement entered into pursuant to this subdivision may provide that

after claims have been audited by the contract administrator or other

service provider, the contract administrator or other service provider

shall periodically inform the public corporation of the total amount

payable in satisfaction of the audited and approved claims, together

with such other supporting information as the public corporation may

require, and the public corporation may transfer moneys in that amount

to the contract administrator or other service provider for disbursement

to the claimants entitled thereto. Any such agreement shall provide that

if a check issued by the contract administrator or other service

provider in satisfaction of a claim remains unpaid after one hundred

eighty days, the moneys payable in satisfaction of that claim shall be

returned to the public corporation.

(c) Any agreement entered into pursuant to this subdivision shall

contain, at a minimum, the following:

(i) a clear statement of the charges, fees or other compensation for

the services provided under the agreement;

(ii) a statement that payment for the services provided under the

agreement shall be made only after the services are rendered;

(iii) a provision stating that the contract administrator or other

service provider to which functions are delegated shall be liable to the

public corporation for all loss or damage that may result from any

failure by the contract administrator or other service provider to

discharge their duties, or from any improper or incorrect discharge of

those duties, and a provision that expressly reserves to the public

corporation all legal rights of set-off. The contract administrator or

service provider shall save the public corporation free and harmless

from any and all loss occasioned by or incurred in the performance of

services under an agreement pursuant to this subdivision;

(iv) a provision requiring the contract administrator or other service

provider to furnish a surety bond, irrevocable letter of credit or

equivalent security, in a form and amount acceptable to the governing

board of the public corporation, to secure the contract administrator's

or other service provider's performance under the agreement;

(v) a provision requiring the contract administrator or service

provider to establish, maintain and retain for a specified period

complete and accurate books, records, documents, accounts and other

evidence pertinent to performance under the agreement, and to submit

quarterly and annual reports, in a form acceptable to the governing

board of the public corporation, detailing the payment of claims and

other activities of the contract administrator or other service provider

during the relevant period. The auditing body or official of the public

corporation shall have access to and may examine such books, records,

documents, accounts and other evidence pertinent to performance under

the agreement upon reasonable notice to the contract administrator or

service provider;

(vi) a provision requiring an annual audit, and opinions thereon, by

an independent certified public accountant, of the accounting procedures

and internal control procedures of the contract administrator or other

service provider;

(vii) a provision by which the contract administrator or other service

provider agrees to maintain the confidentiality of medical records in

its possession and that such confidentiality may only be waived upon the

written consent of the covered person; and

(viii) a provision by which the contract administrator or other

service provider acknowledges that those records maintained on behalf of

the public corporation are subject to the provisions of article six of

the public officers law.

(d) A contract entered into pursuant to this section shall be for a

term not to exceed five years, except that it shall be subject to

cancellation by the municipal corporation at any time upon thirty days'

notice.

7. The provisions of this section shall permit a public corporation to

provide coverage for volunteer firefighters, as defined in section three

of the volunteer firefighters' benefit law, and volunteer ambulance

workers, as defined in subdivision one of section three of the volunteer

ambulance workers' benefit law, provided however, that the total cost of

participation by such volunteers and their families shall be borne by

such volunteers.