[Close this window]

§ 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.

[Close this window]