§ 4704 — Conditions for issuance of certificate of authority

§ 4704. Conditions for issuance of certificate of authority. (a) The\nsuperintendent shall issue a certificate of authority to a municipal\ncooperative health benefit plan if all of the following conditions,\nafter examination and investigation, have been met to the\nsuperintendent's satisfaction:\n (1) a complete application has been filed with the superintendent in\naccordance with section four thousand seven hundred three of this\narticle;\n (2) except for any plan that provided medical, surgical and hospital\nservices on or before January first, nineteen hundred ninety-three\npursuant to a municipal cooperation agreement, the number of municipal\ncorporations participating in the municipal cooperative health benefit\nplan shall be at least three;\n (3) except for any plan that provided medical, surgical and hospital\nservices to at least three hundred fifty covered employees (including\nretirees and not including dependents) on or before January first,\nnineteen hundred ninety-three pursuant to a municipal cooperation\nagreement, the number of covered employees (including retirees and not\nincluding dependents) of municipal corporations participating in the\nmunicipal cooperative health benefit plan shall be at least two\nthousand;\n (4) the municipal cooperative health benefit plan is or shall be\noperated pursuant to a municipal cooperation agreement satisfying the\nrequirements set forth in section four thousand seven hundred five of\nthis article;\n (5) the municipal cooperative health benefit plan has within its own\norganization adequate facilities and competent personnel to service the\nplan or, in order to provide such services, in whole or part, has\ncontracted with a contract administrator or other service provider,\ndetermined by the governing board to be qualified based upon written\ndocumentation furnished to the governing board, provided that such\ndocumentation shall be made available to the superintendent upon\nrequest;\n (6) the municipal cooperative health benefit plan possesses a written\ncommitment, binder or policy for stop-loss insurance issued by an\ninsurance company authorized to do business in this state, to the extent\nrequired by section four thousand seven hundred seven of this article;\n (7) the municipal cooperative health benefit plan establishes premium\nequivalent rates sufficient to meet its contractual obligations and to\nsatisfy the reserve and surplus requirements set forth in section four\nthousand seven hundred six of this article;\n (8) the municipal cooperative health benefit plan has established a\nfair and equitable process for claims review, dispute resolution and\nappeal procedures including arbitration of rejected claims, and\nprocedures for handling claims for benefits in the event of plan\ndissolution, which are satisfactory to the superintendent;\n (9) the municipal cooperative health benefit plan has delivered to the\nsuperintendent such bond, deposit or security for protection of the\nemployees and retirees and their dependents covered by the plan as the\nsuperintendent shall require in the event that the plan's chief fiscal\nofficer is not otherwise adequately bonded under the provisions of the\neducation law, general municipal law or public officers law;\n (10) the municipal cooperative health benefit plan provides to covered\nemployees and retirees of participating municipal corporations written\nnotice disclosing the information required by section four thousand\nseven hundred nine of this article; and\n (11) all plan documents, including the summary plan description, and\namendments thereto, have been filed with and approved by the\nsuperintendent in accordance with section four thousand seven hundred\nnine of this article.\n (b) The superintendent shall refuse to grant a certificate of\nauthority to an applicant that fails to meet the requirements of this\nsection. Notice of refusal shall be in writing and shall set forth the\nbasis for the refusal. If the applicant submits a written request within\nthirty days after receipt of the notice of refusal, the superintendent\nshall promptly conduct a hearing to give the applicant the opportunity\nto show cause why the refusal should not be made final.\n (c) After any municipal cooperative health benefit plan receives a\ncertificate of authority, it may be joined by additional municipal\ncorporations that execute a municipal cooperation agreement identical\nwith the instruments in effect at that time and which the other\nparticipating municipal corporations have executed.\n