Municipal Cooperative Health Benefit Plans

Application for Certificate of Authority

According to Article 47 of the Insurance Law, a Certificate of Authority is required to establish and maintain a Municipal Cooperative Health Benefit Plan in New York State. The instructions and application forms for the Certificate may now be obtained from the Department website.

You can download the Application Packet (PDF), which contains the following:

  • Application For Certificate Of Authority
  • Exhibit A - Municipal Cooperation Agreement
  • Exhibit B (1) - Actuary Statement As To Surplus Of The Plan
  • Exhibit B (2) - Actuarial Statement As To Soundness Of Premium Equivalent Rates
  • Exhibit C - Required Stop Loss Insurance
  • Exhibit D - Proposed Plan Of Operation and Funding
  • Exhibit E - Application For Approval Of Community Rating Methodology

The following supporting documents must be included with the application:

  • Municipal Cooperation Agreement (Exhibit A) and any other documents describing the rights and obligations of municipal corporations participating in the Plan. For plans that provided medical, surgical or hospital benefits prior to January 1, 1993, also include a copy of the Municipal Cooperation Agreement authorized under 5-G of the General Municipal Law.
  • The Plan document and summary plan description, and amendments thereto.
  • All agreements between that Plan and any party listed in item 8 of the application.
  • A qualified actuary's opinion that the Plan is actuarially sound and that premium equivalent rates have been established at the level sufficient to maintain required reserves, together with an accompanying memorandum describing the calculations, assumptions and methodology made in support of such opinion. Such opinion and accompanying memorandum shall conform to the requirements set forth in Exhibits B1 and B2.
  • A statement, certified by the Governing Board, that adequate aggregate and specific stop-loss insurance coverage has been obtained and maintained (See Exhibit C).
  • A proposed plan of operation and funding (See Exhibit D).
  • Application for approval of the community rating methodologies employed to establish premium equivalent rates (See Exhibit E).
  • Two original applications and attached documents are to be submitted to the following addresses:

Mr. Ergys Shanaj
Assistant Chief
New York State Department of Financial Services
Health Bureau
One State Street, 11th Floor
New York, NY 10004


Ms. Kimberly Luke
Associate Attorney
New York State Department of Financial Services
Health Bureau
One Commerce Plaza
Albany, NY 12257

Municipal Cooperative Health Benefit Plan FAQs


Questions relating to Municipal Cooperative Health Benefit Plans should be directed to [email protected].