N.Y. Insurance Law § 4704: Conditions for issuance of certificate of authority

§ 4704. Conditions for issuance of certificate of authority. (a) The

superintendent shall issue a certificate of authority to a municipal

cooperative health benefit plan if all of the following conditions,

after examination and investigation, have been met to the

superintendent's satisfaction:

(1) a complete application has been filed with the superintendent in

accordance with section four thousand seven hundred three of this

article;

(2) except for any plan that provided medical, surgical and hospital

services on or before January first, nineteen hundred ninety-three

pursuant to a municipal cooperation agreement, the number of municipal

corporations participating in the municipal cooperative health benefit

plan shall be at least three;

(3) except for any plan that provided medical, surgical and hospital

services to at least three hundred fifty covered employees (including

retirees and not including dependents) on or before January first,

nineteen hundred ninety-three pursuant to a municipal cooperation

agreement, the number of covered employees (including retirees and not

including dependents) of municipal corporations participating in the

municipal cooperative health benefit plan shall be at least two

thousand;

(4) the municipal cooperative health benefit plan is or shall be

operated pursuant to a municipal cooperation agreement satisfying the

requirements set forth in section four thousand seven hundred five of

this article;

(5) the municipal cooperative health benefit plan has within its own

organization adequate facilities and competent personnel to service the

plan or, in order to provide such services, in whole or part, has

contracted with a contract administrator or other service provider,

determined by the governing board to be qualified based upon written

documentation furnished to the governing board, provided that such

documentation shall be made available to the superintendent upon

request;

(6) the municipal cooperative health benefit plan possesses a written

commitment, binder or policy for stop-loss insurance issued by an

insurance company authorized to do business in this state, to the extent

required by section four thousand seven hundred seven of this article;

(7) the municipal cooperative health benefit plan establishes premium

equivalent rates sufficient to meet its contractual obligations and to

satisfy the reserve and surplus requirements set forth in section four

thousand seven hundred six of this article;

(8) the municipal cooperative health benefit plan has established a

fair and equitable process for claims review, dispute resolution and

appeal procedures including arbitration of rejected claims, and

procedures for handling claims for benefits in the event of plan

dissolution, which are satisfactory to the superintendent;

(9) the municipal cooperative health benefit plan has delivered to the

superintendent such bond, deposit or security for protection of the

employees and retirees and their dependents covered by the plan as the

superintendent shall require in the event that the plan's chief fiscal

officer is not otherwise adequately bonded under the provisions of the

education law, general municipal law or public officers law;

(10) the municipal cooperative health benefit plan provides to covered

employees and retirees of participating municipal corporations written

notice disclosing the information required by section four thousand

seven hundred nine of this article; and

(11) all plan documents, including the summary plan description, and

amendments thereto, have been filed with and approved by the

superintendent in accordance with section four thousand seven hundred

nine of this article.

(b) The superintendent shall refuse to grant a certificate of

authority to an applicant that fails to meet the requirements of this

section. Notice of refusal shall be in writing and shall set forth the

basis for the refusal. If the applicant submits a written request within

thirty days after receipt of the notice of refusal, the superintendent

shall promptly conduct a hearing to give the applicant the opportunity

to show cause why the refusal should not be made final.

(c) After any municipal cooperative health benefit plan receives a

certificate of authority, it may be joined by additional municipal

corporations that execute a municipal cooperation agreement identical

with the instruments in effect at that time and which the other

participating municipal corporations have executed.