Amd §§92-a, 119-n & 119-o, Gen Muni L; amd §§4702, 4704, 4705 & 4706, Ins L
Authorizes municipalities and districts to enter into cooperative agreements for the provision of centralized public employee administrative and personnel services; provides for health insurance coverage of municipal employees pursuant to standardized health insurance contracts; authorizes the provision of reduced premiums for municipal health insurance plans which offer wellness programs.
STATE OF NEW YORK
________________________________________________________________________
2828
2023-2024 Regular Sessions
IN ASSEMBLY
January 27, 2023
___________
Introduced by M. of A. ZEBROWSKI, WALLACE, NORRIS -- read once and
referred to the Committee on Local Governments
AN ACT to amend the general municipal law, in relation to authorizing
cities, towns, villages, school districts, boards of cooperative
educational services, library districts, fire districts, improvement
districts and special districts to enter into cooperative agreements
for the provision of centralized public employee administrative and
personnel services; and to amend the insurance law, in relation to
authorizing reduction of premiums for municipal cooperative health
benefit plans which offer employee wellness programs
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 92-a of the general municipal law is amended by
2 adding a new subdivision 8 to read as follows:
3 8. The provisions of this section shall not apply to any public corpo-
4 ration which provides health insurance benefits to its officers and
5 employees pursuant to article forty-seven of the insurance law.
6 § 2. Subdivision a of section 119-n of the general municipal law, as
7 amended by chapter 413 of the laws of 1991, is amended to read as
8 follows:
9 a. The term "municipal corporation" means a county outside the city of
10 New York, a city, a town, a village, a board of cooperative educational
11 services, a public library as defined in section two hundred fifty-three
12 of the education law, a fire district or a school district.
13 § 3. Subdivision 2 of section 119-o of the general municipal law is
14 amended by adding a new paragraph b-1 to read as follows:
15 b-1. The establishment of a centralized office to collectively
16 provide:
17 (i) employee payroll, time, attendance and personnel administration
18 services;
19 (ii) participation in the New York state health insurance program;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD06871-01-3
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1 (iii) a personnel office to provide information on employee health
2 insurance and other employee benefits;
3 (iv) employee health insurance benefits from more than one health
4 insurance carrier or organization, which grants each employee the choice
5 of which health insurance plan which will provide coverage;
6 (v) employee participation in tax deferred retirement plans, health
7 care plans and child care plans;
8 (vi) municipal cooperative health benefit plans pursuant to article
9 forty-seven of the insurance law;
10 (vii) adequate and ongoing financial controls and security arrange-
11 ments to ensure that the participating municipal corporations and
12 districts remain solvent;
13 (viii) the preparation and dissemination of informational and solic-
14 itation materials to facilitate comparison of the various employee
15 health insurance plans offered by the participating municipal corpo-
16 rations and districts;
17 (ix) for the enrollment, billing, premium collection, premium
18 disbursement and reconciliation, commission disbursement, and other
19 processing services for health insurance benefits provided to municipal
20 employees;
21 (x) contracting with qualified third parties for the provision of any
22 service necessary to carry out such office's powers and duties; and
23 (xi) negotiation with participating health insurers and health mainte-
24 nance organizations with regard to the administrative expenses portion
25 of premium rates charged for health care coverage offered to municipal
26 employees by such office.
27 § 4. Subsections (a) and (f) of section 4702 of the insurance law, as
28 added by chapter 689 of the laws of 1994, are amended and a new
29 subsection (i-1) is added to read as follows:
30 (a) "Community rating" means a rating methodology in which the premium
31 equivalent rate for all persons covered under a municipal cooperative
32 health benefit plan is the same, based upon the experience of the entire
33 pool of risks covered under the plan, without regard to age, sex, health
34 status or occupation and such that refunds, rebates, credits or divi-
35 dends based upon age, sex, health status or occupation are not
36 permitted; provided, however, that, subject to the approval of the
37 superintendent, such plan may provide an actuarially appropriate
38 reduction in premium rates in return for an enrollee's or insured's
39 adherence to a bona fide wellness program. A bona fide wellness program
40 is either a risk management system that identifies at-risk populations
41 or any other systematic program or course of medical conduct which helps
42 to promote good health, helps to prevent or mitigate acute or chronic
43 sickness or disease, or which minimizes adverse health consequences due
44 to lifestyle. Such wellness program shall demonstrate actuarially that
45 it encourages the general good health and well-being of the covered
46 population. Such plan shall not require specific outcomes as a result of
47 an enrollee's or insured's adherence to the approved wellness program.
48 (f) "Municipal corporation" means within the state of New York, a city
49 [with a population of less than one million or], a county outside the
50 city of New York, town, village, board of cooperative educational
51 services, school district, a fire district, a public library, as defined
52 in section two hundred fifty-three of the education law, or district, as
53 defined in section one hundred nineteen-n of the general municipal law.
54 (i-1) "Stop-loss insurance" means an insurance policy whereby the
55 insurer agrees to pay claims or indemnify a municipal corporation for
56 losses incurred under a municipal cooperative health benefit plan in
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1 excess of specified loss limits for individual claims and/or for all
2 claims combined, or any similar arrangement.
3 § 5. Paragraphs 2 and 3 of subsection (a) of section 4704 of the
4 insurance law, paragraph 2 as amended by section 3 of part A of chapter
5 494 of the laws of 2009 and paragraph 3 as added by chapter 689 of the
6 laws of 1994, are amended to read as follows:
7 (2) except for any plan that provided medical, surgical and hospital
8 services on or before January first, nineteen hundred ninety-three
9 pursuant to a municipal cooperation agreement, the number of municipal
10 corporations participating in the municipal cooperative health benefit
11 plan shall be at least [three] two;
12 (3) except for any plan that provided medical, surgical and hospital
13 services to at least three hundred fifty covered employees (including
14 retirees and not including dependents) on or before January first, nine-
15 teen hundred ninety-three pursuant to a municipal cooperation agreement,
16 the number of covered employees (including retirees and not including
17 dependents) of municipal corporations participating in the municipal
18 cooperative health benefit plan shall be at least [two thousand] five
19 hundred;
20 § 6. Subsection (b) of section 4704 of the insurance law, as added by
21 chapter 689 of the laws of 1994, is amended to read as follows:
22 (b) The superintendent shall refuse to grant a certificate of authori-
23 ty to an applicant that fails to meet the requirements of this section.
24 Notice of refusal shall be in writing and shall set forth the basis for
25 the refusal. If the applicant submits a written request within [thirty]
26 sixty days after receipt of the notice of refusal, the superintendent
27 shall promptly conduct a hearing to give the applicant the opportunity
28 to show cause why the refusal should not be made final.
29 § 7. Paragraphs 1, 2 and 5 of subsection (d) of section 4705 of the
30 insurance law, paragraphs 1 and 5 as added by chapter 689 of the laws of
31 1994 and paragraph 2 as amended by chapter 681 of the laws of 2002, are
32 amended to read as follows:
33 (1) shall design the plan or plans of benefits provided or offered by
34 the municipal cooperative health benefit plan and prepare the plan docu-
35 ment and summary plan description in accordance with section four thou-
36 sand seven hundred nine of this article, and shall include a wellness
37 program option;
38 (2) may enter into an agreement with a contract administrator or other
39 service provider, determined by the governing board to be qualified, to
40 receive, investigate, recommend, audit, approve or make payment of
41 claims under the municipal cooperative health benefit plan or plans,
42 provided that:
43 (A) the charges, fees and other compensation for any contracted
44 services shall be clearly stated in written administrative services
45 contracts as required in subdivision six of section ninety-two-a of the
46 general municipal law;
47 (B) payment for contracted services shall be made only after such
48 services are rendered; and
49 (C) no member of the plan's governing board or any member of such
50 member's immediate family shall be an owner, officer, director, partner,
51 or employee of any contract administrator retained by the plan[; and
52 (D) all such agreements shall comply with the requirements of subdivi-
53 sion six of section ninety-two-a of the general municipal law].
54 (5) shall prepare an annual budget for the municipal cooperative
55 health benefit plan to determine the premium equivalent rates for
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1 participating municipal corporations to be deposited in the plan's joint
2 fund or funds during the fiscal year, provided that:
3 (A) the governing board shall designate the bank or trust company in
4 which joint funds, including reserve funds, are to be deposited and
5 which shall be located in this state, duly chartered under federal law
6 or the laws of this state; and
7 (B) the governing board shall establish premium equivalent rates for
8 participating municipal corporations on the [bases] basis of a community
9 rating methodology filed with and approved by the superintendent and, in
10 determining the annual premium equivalent rates, the governing board:
11 (i) may contract for necessary actuarial services to estimate expected
12 plan expenditures during the fiscal year;
13 (ii) shall maintain reserves in amounts equal to or exceeding the
14 minimum amounts required by section four thousand seven hundred six of
15 this article; and
16 (iii) shall maintain a stop-loss policy or policies, to the extent
17 required by section four thousand seven hundred seven of this article;
18 § 8. Subparagraphs (A) and (B) of paragraph 5 of subsection (a) of
19 section 4706 of the insurance law, as added by chapter 689 of the laws
20 of 1994, are amended to read as follows:
21 (A) five percent of the annualized earned premium equivalents during
22 the current fiscal year of a municipal cooperative health benefit plan
23 which consists of [five] two or more participating municipal corpo-
24 rations and covers [two thousand] five hundred or more employees and
25 retirees; or
26 (B) seven percent of the annualized earned premium equivalents during
27 the current fiscal year of the municipal cooperative health benefit plan
28 which consists of [four] two or fewer participating municipal corpo-
29 rations or covers fewer than [two thousand] five hundred employees and
30 retirees.
31 § 9. This act shall take effect on the first of January next succeed-
32 ing the date on which it shall have become a law.
