N.Y. Insurance Law § 4707: Stop-loss requirements

§ 4707. Stop-loss requirements. (a) The governing board of a municipal

cooperative health benefit plan shall obtain and maintain on behalf of

the plan a stop-loss insurance policy or policies delivered in this

state and issued by a licensed insurer, providing:

(1) aggregate stop-loss coverage with an annual aggregate retention

amount or attachment point not greater than one hundred twenty-five

percent of the amount certified by a qualified actuary to represent the

expected claims of the plan for the current fiscal year; and

(2) specific stop-loss coverage with a specific retention amount or

attachment point not greater than four percent of the amount certified

by a qualified actuary to represent the plan's expected claims for the

current fiscal year.

(b) Upon application of the governing board, the superintendent may

waive the requirement for the stop-loss insurance, in whole or part, or

modify the maximum retention amounts or attachment points for stop-loss

insurance, provided that:

(1) the plan maintains reserves and surplus equal to or greater than

one hundred fifty percent of the amounts specified in paragraphs one and

five of subsection (a) of section four thousand seven hundred six of

this article; or

(2) the superintendent is satisfied that such waiver or modification

of retention amounts or attachment points would not be detrimental to

the plan's solvency and stability, after considering such factors as

availability and affordability of stop-loss insurance, the plan's past

and expected experience, plan size, reserves, surplus, and premium

equivalent rates, and the contingent liability of participating

municipal corporations.

(c) As an alternative to suspension or revocation pursuant to section

four thousand seven hundred twelve of this article, the superintendent

may reduce the aggregate or specific stop-loss retention amounts or

attachment points specified in subsection (a) of this section for any

municipal cooperative health benefit plan that fails to maintain

required reserves and surplus.