New York Insurance Law Section 4707 - Stop-loss requirements.

 4707. Stop-loss requirements. (a) The governing board of a municipal
  cooperative  health  benefit plan shall obtain and maintain on behalf of
  the plan a stop-loss insurance policy  or  policies  delivered  in  this
  state and issued by a licensed insurer, providing:

(1)  aggregate  stop-loss  coverage with an annual aggregate retention
  amount or attachment point not  greater  than  one  hundred  twenty-five
  percent  of the amount certified by a qualified actuary to represent the
  expected claims of the plan for the current fiscal year; and

(2) specific stop-loss coverage with a specific  retention  amount  or
  attachment  point  not greater than four percent of the amount certified
  by a qualified actuary to represent the plan's expected claims  for  the
  current fiscal year.

(b)  Upon  application  of the governing board, the superintendent may
  waive the requirement for the stop-loss insurance, in whole or part,  or
  modify  the maximum retention amounts or attachment points for stop-loss
  insurance, provided that:

(1) the plan maintains reserves and surplus equal to or  greater  than
  one hundred fifty percent of the amounts specified in paragraphs one and
  five  of  subsection  (a)  of section four thousand seven hundred six of
  this article; or

(2) the superintendent is satisfied that such waiver  or  modification
  of  retention  amounts  or attachment points would not be detrimental to
  the plan's solvency and stability, after  considering  such  factors  as
  availability  and  affordability of stop-loss insurance, the plan's past
  and expected experience,  plan  size,  reserves,  surplus,  and  premium
  equivalent   rates,   and  the  contingent  liability  of  participating
  municipal corporations.

(c) As an alternative to suspension or revocation pursuant to  section
  four  thousand  seven hundred twelve of this article, the superintendent
  may reduce the aggregate or  specific  stop-loss  retention  amounts  or
  attachment  points  specified  in subsection (a) of this section for any
  municipal  cooperative  health  benefit  plan  that  fails  to  maintain
  required reserves and surplus.

Last modified: February 3, 2019