Sec. 21.42.145. Stop-loss insurance provisions.

329 words·~1 min read·/ak/title-21/chapter-42/21-42-145

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(a)An insurance company licensed under AS 21.09 , a hospital or medical service corporation licensed under AS 21.87 , a fraternal benefit society licensed under AS 21.84 , a health maintenance organization licensed under AS 21.86 , or a multiple employer welfare arrangement may not issue a stop-loss insurance policy that

(1)has an annual attachment point for claims incurred for each individual that is lower than $10,000;

(2)has an annual aggregate attachment point for a small employer that is lower than the greatest of

(A)$4,000 times the number of individuals covered under the health benefit plan;

(B)120 percent of the expected claims for the health benefit plan for the period covered by the stop-loss insurance policy; or

(C)$20,000;

(3)has an annual aggregate attachment point for a large employer that is lower than 110 percent of expected claims for the health benefit plan for the period covered by the stop-loss insurance policy; or

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

(b)The director may, by regulation, change the dollar amounts established under

(a)of this section to reflect medical costs in this state, including adjustments to reflect changes in the medical care component of the Consumer Price Index for all urban consumers for the Anchorage Metropolitan Area compiled by the Bureau of Labor Statistics, United States Department of Labor.

(c)For the purposes of this section,

(1)“attachment point” means the claim amount incurred by an insured group beyond which the insurer incurs a liability for payment;

(2)“expected claims” means the amount of claims that, in absence of a stop-loss insurance policy or other insurance, are projected to be incurred by an insured group through its health benefit plan;

(3)“health benefit plan” has the meaning given in AS 21.54.500 ;

(4)“large employer” has the meaning given in AS 21.54.500 ;

(5)“small employer” has the meaning given in AS 21.54.500 .