N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 362-5.4

Current through Register Vol. 46, No. 43, October 23, 2024

Section 362-5.4 - Stop loss fund administration

(a) The superintendent shall establish the funds and oversee fund administration. The functions of the superintendent in this regard may include, but shall not be limited to, the following:

(1) choosing a firm or firms, other than a carrier participating in the funds, to administer the funds, based on an evaluation of competitive bids;

(2) granting approval of the general systems and procedures used by the firm or firms to administer the funds, including in particular the procedures utilized to verify the appropriateness of payments from the funds to the health maintenance organizations or participating insurers;

(3) making payment of reasonable fees from the funds to the firm or firms for administration of the funds;

(4) changing the administrating firm or firms, or the administrative systems and procedures, if necessary;

(5) collecting necessary data from health maintenance organizations and participating insurers;

(6) arranging for periodic audits of health maintenance organizations and participating insurers and for the payment of reasonable fees for such audits from the funds; and

(7) granting approval of the format and content of the administrating firm or firms annual report regarding the affairs and operation of the funds, and such other reports as deemed necessary by the superintendent.

(b) Health maintenance organizations and participating insurers must respond to requests for information from the superintendent and/or the fund administrator(s) within 15 business days.

N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 362-5.4