Authorizes a pilot program for a county self-insured or self-funded health plan in Albany and Schenectady counties; provides municipalities of such counties are permitted to join.
STATE OF NEW YORK
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529
2025-2026 Regular Sessions
IN ASSEMBLY(Prefiled)
January 8, 2025
___________
Introduced by M. of A. STECK, SANTABARBARA -- read once and referred to
the Committee on Local Governments
AN ACT in relation to establishing a pilot program for a county self-
funded or self-insured health plan in Albany and Schenectady counties
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. (a) The superintendent of financial services shall author-
2 ize a pilot program for a county self-funded or self-insured health plan
3 in Albany and Schenectady counties. Notwithstanding article 44 or 47 of
4 the insurance law or any other provision of law to the contrary, and
5 subject to the requirements set forth in this section, a municipality
6 located in such counties is permitted, with the consent of the county
7 and the governing body of such municipality, to join such county self-
8 funded or self-insured health plan in the county in which such munici-
9 pality is located in whole or in part. Municipality is defined as any
10 city, town, village or any other municipal corporation, a school
11 district or any governmental entity operating a public school, college
12 or university, a public improvement or special district, a public
13 authority, commission, or public benefit corporation, or any other
14 public corporation, agency or instrumentality or unit of government
15 which exercises governmental powers under the laws of the state but is
16 not a part of, nor a department of, nor an agency of the state. In order
17 for a municipality or municipalities to join such county self-funded or
18 self-insured health plan, the county shall file with the superintendent
19 of financial services certification that, with inclusion of the lives to
20 be covered in the plan following admission of the municipality or muni-
21 cipalities, such plan meets the following six requirements:
22 1. That the county and any municipality or municipalities joining the
23 county self-funded or self-insured health plan have mutually consented
24 to join such plan.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01077-01-5
A. 529 2
1 2. That the county self-funded or self-insured health plan maintains a
2 reserve fund, calculated as a percentage of total annual incurred
3 claims, of a minimum of 12% of claims.
4 3. That the county self-funded or self-insured health plan has a
5 surplus account, established and maintained for the sole purpose of
6 satisfying unexpected obligations of the benefit plan in the event of
7 termination or abandonment of such plan, which shall not be less than 5%
8 of the annualized earned premium equivalents during the current fiscal
9 year of such plan.
10 4. That the county self-funded or self-insured health plan has in
11 effect a specific stop loss per individual claim only, no aggregate,
12 with a minimum deductible of $200,000 to $250,000.
13 5. That the county self-funded or self-insured health plan has a mini-
14 mum of 1,000 covered lives including retirees, but not including depen-
15 dents.
16 6. That joint and several liability of participating municipalities
17 for the obligations of the county self-funded or self-insured health
18 plan is hereby abolished, and such liability shall be governed as
19 follows:
20 (i) If the plan does not have admitted assets, as defined in section
21 107 of the insurance law, at least equal to the aggregate of its liabil-
22 ities and reserves and minimum surplus as provided in paragraph 2 of
23 this subdivision, the governing board of such plan shall, within 30 days
24 thereafter, order an assessment for the amount that will provide suffi-
25 cient funds to remove such impairment and collect from each municipal
26 corporation a pro rata share of such assessed amount.
27 (ii) Every municipal corporation that participated in the plan at any
28 time during the two-year period prior to the issuing of an assessment
29 order by the plan's governing board shall, if notified of such assess-
30 ment, pay its pro rata share of such assessment within 90 days after the
31 issuance of that assessment order.
32 (iii) A municipal corporation's pro rata share of any assessment shall
33 be determined by applying the ratio of (A) the total assessment to the
34 total contributions or premium equivalents earned during the period
35 covered by the assessment on all municipal corporations subject to
36 assessment to (B) the contribution or premium equivalent earned during
37 such period attributable to such municipal corporation.
38 (iv) The contingent liability of municipal corporations for additional
39 premium equivalents or assessments shall not be included as an asset in
40 the financial statements of the plan.
41 (b) The superintendent of financial services shall have the authority
42 to review such certification to determine that the six aforementioned
43 requirements have been met; provided, however, that in the absence of a
44 finding of the superintendent to the contrary within a six-month period
45 following the filing of such certification, the admission of the munici-
46 pality to the county self-funded or self-insured health plan shall take
47 effect. In January of every year following the initial filing of such
48 certification, the county shall file a subsequent certification that the
49 six aforementioned requirements remain in full force and effect.
50 (c) The duration of a county self-funded or self-insured health plan
51 undertaken by participating municipalities shall be at least two years
52 and shall be allowed to become permanent should either county determine
53 the plan to be successful.
54 (d) Thirty months after the effective date of this section, the super-
55 intendent of financial services shall submit a report to the governor,
56 the temporary president of the senate, and the speaker of the assembly,
A. 529 3
1 analyzing the data provided by participating municipalities, as well as
2 recommendations based on the data collected from the pilot program.
3 § 2. This act shall take effect on the ninetieth day after it shall
4 have become a law.
