The office of General Counsel issued the following informal opinion on November 29, 2001, representing the position of the New York State Insurance Department.
RE: Self-Funded Church Plans
1. Does the Insurance Department have any publications that will inform a self-funded church plan of the requirements it must meet?
2. Does the Insurance Department have any guidelines concerning the calculation of premium requirements for a continuation requirement?
1. There are no Insurance Department publications. However, copies of the relevant statutes and regulations were mailed to the inquirer.
2. While there are no Insurance Department guidelines, application of the appropriate statutory standard should allow calculation of the amounts due.
By letter of October 9, 2001, this Office indicated that the inquirers client, a not-for profit organization providing reimbursement to eligible employees for medical expenses on a self-funded basis, was subject to the jurisdiction of this Department, since, as a "Church Plan," it was not covered under the Employee Retirement Income Security Act (ERISA), 29 U.S.C.A. § 1001 et seq. The inquirer seeks more information concerning which minimum benefits the Plan must provide.
As a preliminary matter, please be informed that if the client remains within this Departments jurisdiction, it must be licensed by this Department.
The minimum benefits that must be provided in a group accident & health insurance policy are set forth in New York Insurance Law § 3221(k) through (o) (McKinney 2000), further subject to "freedom of choice" requirements set forth in New York Insurance Law § 4235(f)(4) (McKinney 2000). The requirements for coordination of benefits and coverage of alcohol abuse are set forth in N.Y. Comp. R. & Regs. tit. 11, §§ 52.23 & 52.24 (2000), respectively.
New York Insurance Law § 3221(m)(3) authorizes the employer to collect up to 102% of the cost of the coverage. In the initial August 24, 2001 inquiry, it was indicated that the Plan currently allowed former employees to continue coverage at the same cost as if they had continued in active service. Continuation of this practice would not be violative of New York Insurance Law § 3221(m)(3). If, however, a participating employer desired, and any applicable collective bargaining agreement allowed, the Plan could permit such employer to also require the former employee to pay 102% of the employers own cost.
The above opinion is informal and not binding on any court. For further information you may contact Principal Attorney Alan Rachlin at the New York City Office.