2015 New York Laws
ISC - Insurance
Article 43 - (Insurance) NON-PROFIT MEDICAL AND DENTAL INDEMNITY, OR HEALTH AND HOSPITAL SERVICE CORPORATIONS
4309 - Limitation on expenses.

  4309.  Limitation  on  expenses.  (a) No corporation subject to the
  provisions of this article shall, during any  one  year,  disburse  more
  than the percentages hereafter prescribed of the aggregate amount of the
  premiums  received during such year as expenditures for expenses, which,
  for the purposes of this article, shall include  all  expenses  paid  or
  incurred  by  the  corporation  which do not constitute benefit payments
  made to or on behalf of persons covered under contracts issued  by  such
  corporations:
(1)  For  hospital service corporations: fifteen per centum reduced by
  one per centum for each five million dollars or fraction  thereof  above
  one million dollars of premiums received to ten per centum.
(2)  All  other  corporations:  twenty  per  centum reduced by one per
  centum for each five million  dollars  or  fraction  thereof  above  one
  million  dollars  of premiums received to fifteen per centum except that
  for any corporation which derives more than  fifty  per  centum  of  its
  premiums  received  from  the  sale  of contracts which provide hospital
  service benefits: seventeen and one-half per centum reduced by  one  per
  centum  for  each  five  million  dollars  or fraction thereof above one
  million dollars of premiums received to twelve and one-half per centum.
(3)  Upon  written  application,  the  superintendent  may  waive  the
  limitations  in  paragraph  one  or  two  of  this  subsection  for  any
  corporation which has not attained the  level  of  enrollment  which  it
  needs  to  attain  a  break-even  position.  The  break-even position is
  attained when the amount of annual losses and expenses incurred  by  the
  corporation  is  equal  to  the  amount  of  premiums earned during this
  period. Such corporation shall be subject to  such  limitations  in  the
  calendar  year  following  the  year  in  which  it attains a break-even
  position.
(b) If any such corporation shall in any calendar year make  or  incur
  expenses  as  hereinabove  defined  in  excess  of its expense limit the
  superintendent may, upon written application of such corporation  and  a
  showing  that such corporation has taken steps in accordance with a plan
  submitted by the corporation and approved by  the  superintendent  which
  will  enable it to comply with the provisions of this section during the
  next calendar year, suspend the expense limit for such  corporation  for
  the   calendar   year   in   which  the  excess  was  incurred  but  the
  superintendent  shall  not  suspend  the  expense  limit  for  any  such
  corporation for more than two calendar years in succession.