Section 301 – Stop-loss insurance coverage standards.

• (1) A small employer stop-loss insurance contract shall:
  • (a) be issued to the small employer to provide insurance to the group health benefit plan, not the employees of the small employer;
  • (b) have a contract term with guaranteed rates for at least 12 months, without adjustment, unless there is a change in the benefits provided under the small employer’s health plan during the contract period;
  • (c) include both a specific attachment point and an aggregate attachment point in a contract;
  • (d) align stop-loss plan benefit limitations and exclusions with a small employer’s health plan benefit limitations and exclusions, including any annual or lifetime limits in the employer’s health plan;
  • (e) have an annual specific attachment point that is at least $10,000;
  • (f) have an annual aggregate attachment point that may not be less than 85% of expected claims;
  • (g) pay stop-loss claims:
    • (i) incurred during the contract period; and
    • (ii) paid within 12 months after the expiration date of the contract; and
  • (h) include provisions to cover incurred and unpaid stop-loss claims when the small employer’s stop-loss plan terminates.

• (2) A small employer stop-loss contract shall not:
  • (a) include lasering; and
  • (b) pay claims directly to an individual employee, member, or participant.

Amended by Chapter 244, 2015 General Session