S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3545
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 29, 2019
                                ___________
 
 Introduced  by  M. of A. ZEBROWSKI, SCHIMMINGER, 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:
 
   Section 1. Section 92-a of the general municipal  law  is  amended  by
 adding a new subdivision 8 to read as follows:
   8. THE PROVISIONS OF THIS SECTION SHALL NOT APPLY TO ANY PUBLIC CORPO-
 RATION  WHICH  PROVIDES  HEALTH  INSURANCE  BENEFITS TO ITS OFFICERS AND
 EMPLOYEES PURSUANT TO ARTICLE FORTY-SEVEN OF THE INSURANCE LAW.
   § 2. Subdivision a of section 119-n of the general municipal  law,  as
 amended  by  chapter  413  of  the  laws  of 1991, is amended to read as
 follows:
   a. The term "municipal corporation" means a county outside the city of
 New York, a city, a town, a village, a board of cooperative  educational
 services, A PUBLIC LIBRARY AS DEFINED IN SECTION TWO HUNDRED FIFTY-THREE
 OF THE EDUCATION LAW, A fire district or a school district.
   §  3.  Subdivision  2 of section 119-o of the general municipal law is
 amended by adding a new paragraph b-1 to read as follows:
   B-1.   THE ESTABLISHMENT  OF  A  CENTRALIZED  OFFICE  TO  COLLECTIVELY
 PROVIDE:
   (I)  EMPLOYEE  PAYROLL,  TIME, ATTENDANCE AND PERSONNEL ADMINISTRATION
 SERVICES;
   (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.
              

                                                            LBD02072-01-9

 A. 3545                             2
 
   (III) A PERSONNEL OFFICE TO PROVIDE  INFORMATION  ON  EMPLOYEE  HEALTH
 INSURANCE AND OTHER EMPLOYEE BENEFITS;
   (IV)  EMPLOYEE  HEALTH  INSURANCE  BENEFITS  FROM MORE THAN ONE HEALTH
 INSURANCE CARRIER OR ORGANIZATION, WHICH GRANTS EACH EMPLOYEE THE CHOICE
 OF WHICH HEALTH INSURANCE PLAN WHICH WILL PROVIDE COVERAGE;
   (V) EMPLOYEE PARTICIPATION IN TAX DEFERRED  RETIREMENT  PLANS,  HEALTH
 CARE PLANS AND CHILD CARE PLANS;
   (VI)  MUNICIPAL  COOPERATIVE  HEALTH BENEFIT PLANS PURSUANT TO ARTICLE
 FORTY-SEVEN OF THE INSURANCE LAW;
   (VII) ADEQUATE AND ONGOING FINANCIAL CONTROLS  AND  SECURITY  ARRANGE-
 MENTS  TO  ENSURE  THAT  THE  PARTICIPATING  MUNICIPAL  CORPORATIONS AND
 DISTRICTS REMAIN SOLVENT;
   (VIII) THE PREPARATION AND DISSEMINATION OF INFORMATIONAL  AND  SOLIC-
 ITATION  MATERIALS  TO  FACILITATE  COMPARISON  OF  THE VARIOUS EMPLOYEE
 HEALTH INSURANCE PLANS OFFERED BY  THE  PARTICIPATING  MUNICIPAL  CORPO-
 RATIONS AND DISTRICTS;
   (IX)   FOR   THE  ENROLLMENT,  BILLING,  PREMIUM  COLLECTION,  PREMIUM
 DISBURSEMENT AND  RECONCILIATION,  COMMISSION  DISBURSEMENT,  AND  OTHER
 PROCESSING  SERVICES FOR HEALTH INSURANCE BENEFITS PROVIDED TO MUNICIPAL
 EMPLOYEES;
   (X) CONTRACTING WITH QUALIFIED THIRD PARTIES FOR THE PROVISION OF  ANY
 SERVICE NECESSARY TO CARRY OUT SUCH OFFICE'S POWERS AND DUTIES; AND
   (XI) NEGOTIATION WITH PARTICIPATING HEALTH INSURERS AND HEALTH MAINTE-
 NANCE  ORGANIZATIONS  WITH REGARD TO THE ADMINISTRATIVE EXPENSES PORTION
 OF PREMIUM RATES CHARGED FOR HEALTH CARE COVERAGE OFFERED  TO  MUNICIPAL
 EMPLOYEES BY SUCH OFFICE.
   §  4. Subsections (a) and (f) of section 4702 of the insurance law, as
 added by chapter 689 of  the  laws  of  1994,  are  amended  and  a  new
 subsection (i-1) is added to read as follows:
   (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  divi-
 dends  based  upon  age,  sex,  health  status  or  occupation  are  not
 permitted; PROVIDED, HOWEVER, THAT,  SUBJECT  TO  THE  APPROVAL  OF  THE
 SUPERINTENDENT,   SUCH  PLAN  MAY  PROVIDE  AN  ACTUARIALLY  APPROPRIATE
 REDUCTION IN PREMIUM RATES IN RETURN  FOR  AN  ENROLLEE'S  OR  INSURED'S
 ADHERENCE  TO A BONA FIDE WELLNESS PROGRAM. A BONA FIDE WELLNESS PROGRAM
 IS EITHER A RISK MANAGEMENT SYSTEM THAT IDENTIFIES  AT-RISK  POPULATIONS
 OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS
 TO  PROMOTE  GOOD  HEALTH, HELPS TO PREVENT OR MITIGATE ACUTE OR CHRONIC
 SICKNESS OR DISEASE, OR WHICH MINIMIZES ADVERSE HEALTH CONSEQUENCES  DUE
 TO  LIFESTYLE.  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT
 IT ENCOURAGES THE GENERAL GOOD HEALTH  AND  WELL-BEING  OF  THE  COVERED
 POPULATION. SUCH PLAN SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A RESULT OF
 AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM.
   (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 FIRE 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.
   (I-1)  "STOP-LOSS  INSURANCE"  MEANS  AN  INSURANCE POLICY WHEREBY THE
 INSURER AGREES TO PAY CLAIMS OR INDEMNIFY A  MUNICIPAL  CORPORATION  FOR
 LOSSES  INCURRED  UNDER  A  MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN IN

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 EXCESS OF SPECIFIED LOSS LIMITS FOR INDIVIDUAL  CLAIMS  AND/OR  FOR  ALL
 CLAIMS COMBINED, OR ANY SIMILAR ARRANGEMENT.
   §  5.  Paragraphs  2  and  3  of subsection (a) of section 4704 of the
 insurance law, paragraph 2 as amended by section 3 of part A of  chapter
 494  of  the laws of 2009 and paragraph 3 as added by chapter 689 of the
 laws of 1994, are amended to read as follows:
   (2) except for any plan that provided medical, surgical  and  hospital
 services  on  or  before  January  first,  nineteen hundred ninety-three
 pursuant to a municipal cooperation agreement, the number  of  municipal
 corporations  participating  in the municipal cooperative health benefit
 plan shall be at least [three] TWO;
   (3) except for any plan that provided medical, surgical  and  hospital
 services  to  at  least three hundred fifty covered employees (including
 retirees and not including dependents) on or before January first, nine-
 teen hundred ninety-three pursuant to a municipal cooperation agreement,
 the number of covered employees (including retirees  and  not  including
 dependents)  of  municipal  corporations  participating in the municipal
 cooperative health benefit plan shall be at least  [two  thousand]  FIVE
 HUNDRED;
   §  6. Subsection (b) of section 4704 of the insurance law, as added by
 chapter 689 of the laws of 1994, is amended to read as follows:
   (b) The superintendent shall refuse to grant a certificate of authori-
 ty to an applicant that fails to meet the requirements of this  section.
 Notice  of refusal shall be in writing and shall set forth the basis for
 the refusal. If the applicant submits a written request within  [thirty]
 SIXTY  days  after  receipt of the notice of refusal, the superintendent
 shall promptly conduct a hearing to give the applicant  the  opportunity
 to show cause why the refusal should not be made final.
   §  7.  Paragraphs  1, 2 and 5 of subsection (d) of section 4705 of the
 insurance law, paragraphs 1 and 5 as added by chapter 689 of the laws of
 1994 and paragraph 2 as amended by chapter 681 of the laws of 2002,  are
 amended to read as follows:
   (1)  shall design the plan OR PLANS of benefits provided OR OFFERED by
 the municipal cooperative health benefit plan and prepare the plan docu-
 ment and summary plan description in accordance with section four  thou-
 sand  seven  hundred  nine of this article, AND SHALL INCLUDE A WELLNESS
 PROGRAM OPTION;
   (2) may enter into an agreement with a contract administrator or other
 service provider, determined by the governing board to be qualified,  to
 receive,  investigate,  recommend,  audit,  approve  or  make payment of
 claims under the municipal cooperative health  benefit  plan  OR  PLANS,
 provided that:
   (A)  the  charges,  fees  and  other  compensation  for any contracted
 services shall be clearly  stated  in  written  administrative  services
 contracts  as required in subdivision six of section ninety-two-a of the
 general municipal law;
   (B) payment for contracted services shall  be  made  only  after  such
 services are rendered; AND
   (C)  no  member  of  the  plan's governing board or any member of such
 member's immediate family shall be an owner, officer, director, partner,
 or employee of any contract administrator retained by the plan[; and
   (D) all such agreements shall comply with the requirements of subdivi-
 sion six of section ninety-two-a of the general municipal law].
   (5) shall prepare an  annual  budget  for  the  municipal  cooperative
 health  benefit  plan  to  determine  the  premium  equivalent rates for

 A. 3545                             4
 
 participating municipal corporations to be deposited in the plan's joint
 fund or funds during the fiscal year, provided that:
   (A)  the  governing board shall designate the bank or trust company in
 which joint funds, including reserve funds,  are  to  be  deposited  and
 which  shall  be located in this state, duly chartered under federal law
 or the laws of this state; and
   (B) the governing board shall establish premium equivalent  rates  for
 participating municipal corporations on the [bases] BASIS of a community
 rating methodology filed with and approved by the superintendent and, in
 determining the annual premium equivalent rates, the governing board:
   (i) may contract for necessary actuarial services to estimate expected
 plan expenditures during the fiscal year;
   (ii)  shall  maintain  reserves  in  amounts equal to or exceeding the
 minimum amounts required by section four thousand seven hundred  six  of
 this article; and
   (iii)  shall  maintain  a  stop-loss policy or policies, to the extent
 required by section four thousand seven hundred seven of this article;
   § 8. Subparagraphs (A) and (B) of paragraph 5  of  subsection  (a)  of
 section  4706  of the insurance law, as added by chapter 689 of the laws
 of 1994, are amended to read as follows:
   (A) five percent of the annualized earned premium  equivalents  during
 the  current  fiscal year of a municipal cooperative health benefit plan
 which consists of [five] TWO  or  more  participating  municipal  corpo-
 rations  and  covers  [two  thousand] FIVE HUNDRED or more employees and
 retirees; or
   (B) seven percent of the annualized earned premium equivalents  during
 the current fiscal year of the municipal cooperative health benefit plan
 which  consists  of  [four]  TWO or fewer participating municipal corpo-
 rations or covers fewer than [two thousand] FIVE HUNDRED  employees  and
 retirees.
   §  9. This act shall take effect on the first of January next succeed-
 ing the date on which it shall have become a law.