§ 23-62-111. Employee benefit stop-loss insurance

(a) As used in this subchapter, “employee benefit stop-loss insurance” means coverage that insures an employer or an employer-sponsored health plan against the risk that:

1. (1) One (1) claim will exceed a specific dollar amount; or

2. (2) The entire loss of a self-insurance plan will exceed a specific dollar amount.

(b) An insurer authorized to transact accident and health insurance business in this state may issue employee benefit stop-loss insurance in this state.

(c) An insurer shall not issue an employee benefit stop-loss insurance policy that:

1. (1) Has an annual attachment point for claims incurred per individual that is less than twenty thousand dollars ($20,000);

2. (2) Has an annual aggregate attachment point for groups of fifty (50) or less that is lower than the greater of:

   1. (A) Four thousand dollars ($4,000) multiplied by the number of group members;

   2. (B) One hundred twenty percent (120%) of expected claims; or

   3. (C) Twenty thousand dollars ($20,000);

3. (3) Has an annual aggregate attachment point for groups of fifty-one (51) or more that is lower than one hundred ten percent (110%) of expected claims; or

4. (4) Provides for direct coverage of health care expenses of an individual.

(d) The Insurance Commissioner may adopt rules that carry out the requirements of this section, including without limitation rules that require:

1. (1) Additional standards for employee benefit stop-loss insurance policies; and

2. (2) Disclosures to policyholders by an insurance carrier providing employee benefit stop-loss insurance.