11 CRR-NY 361.7NY-CRR

STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 11. INSURANCE
CHAPTER XIV. INDIVIDUAL AND SMALL GROUP HEALTH INSURANCE AND FAMILY LEAVE BENEFITS COVERAGE
PART 361. ESTABLISHMENT AND OPERATION OF MARKET STABILIZATION MECHANISMS FOR CERTAIN HEALTH INSURANCE MARKETS
11 CRR-NY 361.7
11 CRR-NY 361.7
361.7 Pool administration.
(a) The pools shall be administered either directly by the superintendent, or in conjunction with a firm, performing at least the following functions:
(1) choosing a firm or firms, other than a carrier participating in any of the pools, to administer the pools, based on an evaluation of competitive bids;
(2) approval of the general systems and procedures used by the firm or firms to administer the pools, including in particular procedures to verify the appropriateness of payments from the pools to carriers;
(3) payment of reasonable fees from the pooling funds to the firm or firms for administration of the pools;
(4) changing the administrating firm or firms, or the administrative systems and procedures, if necessary;
(5) the collection from pool participants of the data needed to administer the pools;
(6) the arrangement for periodic audits of the pools, including the participation of each carrier, and paying from the pooling funds reasonable fees for such audits;
(7) the reporting to the carriers participating in the pools a summary of the operations of the pools, on a periodic basis, but in no event less often than annually; and
(8) establishing equitable assessments on carriers participating in the pools as needed to make the payments from the pools stated in paragraphs (3) and (6) of this subdivision, in sections 361.3(f), 361.4(c) and (d) and 361.5(d) of this Part.
(b) The superintendent may seek advice and recommendations regarding the functions listed above, or regarding other functions, from the Technical Advisory Committee, established in accordance with section 3233(b) of the Insurance Law.
(c) Carriers participating in the pools must respond to questions or objections raised by the superintendent or a designated pool administrator within 15 days.
11 CRR-NY 361.7
Current through May 31, 2021
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