§ 4707 — Stop-loss requirements

New York § 4707

• Jurisdiction: New York
• Law ISC: Insurance
• Art. 47: Municipal Cooperative Health Benefit Plans

Text

§ 4707. Stop-loss requirements. (a) The governing board of a municipal\ncooperative health benefit plan shall obtain and maintain on behalf of\nthe plan a stop-loss insurance policy or policies delivered in this\nstate and issued by a licensed insurer, providing:\n (1) aggregate stop-loss coverage with an annual aggregate retention\namount or attachment point not greater than one hundred twenty-five\npercent of the amount certified by a qualified actuary to represent the\nexpected claims of the plan for the current fiscal year; and\n (2) specific stop-loss coverage with a specific retention amount or\nattachment point not greater than four percent of the amount certified\nby a qualified actuary to represent the plan's expected claims for the\ncurrent fiscal year.\n (b) Upon application of the governing board, the superintendent may\nwaive the requirement for the stop-loss insurance, in whole or part, or\nmodify the maximum retention amounts or attachment points for stop-loss\ninsurance, provided that:\n (1) the plan maintains reserves and surplus equal to or greater than\none hundred fifty percent of the amounts specified in paragraphs one and\nfive of subsection (a) of section four thousand seven hundred six of\nthis article; or\n (2) the superintendent is satisfied that such waiver or modification\nof retention amounts or attachment points would not be detrimental to\nthe plan's solvency and stability, after considering such factors as\navailability and affordability of stop-loss insurance, the plan's past\nand expected experience, plan size, reserves, surplus, and premium\nequivalent rates, and the contingent liability of participating\nmunicipal corporations.\n (c) As an alternative to suspension or revocation pursuant to section\nfour thousand seven hundred twelve of this article, the superintendent\nmay reduce the aggregate or specific stop-loss retention amounts or\nattachment points specified in subsection (a) of this section for any\nmunicipal cooperative health benefit plan that fails to maintain\nrequired reserves and surplus.\n