§ 4704. Conditions for issuance of certificate of authority. (a) The
superintendent shall issue a certificate of authority to a municipal
cooperative health benefit plan if all of the following conditions,
after examination and investigation, have been met to the
superintendent's satisfaction:

(1) a complete application has been filed with the superintendent in
accordance with section four thousand seven hundred three of this
article;

(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;

(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,
nineteen 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;

(4) the municipal cooperative health benefit plan is or shall be
operated pursuant to a municipal cooperation agreement satisfying the
requirements set forth in section four thousand seven hundred five of
this article;

(5) the municipal cooperative health benefit plan has within its own
organization adequate facilities and competent personnel to service the
plan or, in order to provide such services, in whole or part, has
contracted with a contract administrator or other service provider,
determined by the governing board to be qualified based upon written
documentation furnished to the governing board, provided that such
documentation shall be made available to the superintendent upon
request;

(6) the municipal cooperative health benefit plan possesses a written
commitment, binder or policy for stop-loss insurance issued by an
insurance company authorized to do business in this state, to the extent
required by section four thousand seven hundred seven of this article;

(7) the municipal cooperative health benefit plan establishes premium
equivalent rates sufficient to meet its contractual obligations and to
satisfy the reserve and surplus requirements set forth in section four
thousand seven hundred six of this article;

(8) the municipal cooperative health benefit plan has established a
fair and equitable process for claims review, dispute resolution and
appeal procedures including arbitration of rejected claims, and
procedures for handling claims for benefits in the event of plan
dissolution, which are satisfactory to the superintendent;

(9) the municipal cooperative health benefit plan has delivered to the
superintendent such bond, deposit or security for protection of the
employees and retirees and their dependents covered by the plan as the
superintendent shall require in the event that the plan's chief fiscal
officer is not otherwise adequately bonded under the provisions of the
education law, general municipal law or public officers law;

(10) the municipal cooperative health benefit plan provides to covered
employees and retirees of participating municipal corporations written
notice disclosing the information required by section four thousand
seven hundred nine of this article; and

(11) all plan documents, including the summary plan description, and
amendments thereto, have been filed with and approved by the
superintendent in accordance with section four thousand seven hundred
nine of this article.

(b) The superintendent shall refuse to grant a certificate of
authority 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 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.

(c) After any municipal cooperative health benefit plan receives a
certificate of authority, it may be joined by additional municipal
corporations that execute a municipal cooperation agreement identical
with the instruments in effect at that time and which the other
participating municipal corporations have executed.