N.Y. Insurance Law § 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.