New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter XIV - Individual And Small Group Health Insurance
Part 362 - The Healthy New York Program And The Direct Payment Stop Loss Relief Program
Subpart 362-5 - Rules Relating To The Direct Payment Market Stop Loss Relief Program And State Funded Stop Loss Relief For The Healthy New York Program
Section 362-5.4 - Stop loss fund administration
Universal Citation: 11 NY Comp Codes Rules and Regs ยง 362-5.4
Current through Register Vol. 46, No. 39, September 25, 2024
(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.
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