31A-43-301. Stop-loss insurance standards.

309 words·~1 min read·/ut/title-31a/chapter-43/31a-43-301

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Effective 7/1/2025

(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)subject to Subsection

(4):

(i)have an annual specific attachment point that is at least $25,000; and

(ii)have an annual aggregate attachment point that may not be less than 90% of expected claims;

(f)pay stop-loss claims:

(i)incurred during the contract period; and

(ii)paid within 12 months after the expiration date of the contract; and

(g)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 insurance contract may not:

(a)include lasering; and

(b)pay claims directly to an individual employee, member, or participant.

(3)A stop-loss insurer or reinsurer:

(a)may enter into a small employer stop-loss insurance contract with a small employer with 10 or more enrolled employees; and

(b)may not enter into a small employer stop-loss insurance contract with a small employer with less than 10 enrolled employees.

(4)The provisions of this section do not apply to a small employer stop-loss insurance contract entered into before July 1, 2025, unless the insurance provider changes under the small employer's health plan during the contract period.

Amended by Chapter 175 , 2025 General Session