Chapter 092
2013 -- S 0666 SUBSTITUTE A
Enacted 06/17/13
A N A C T
RELATING TO
INSURANCE
Introduced By: Senator David E. Bates
Date Introduced: March 06, 2013
It is enacted by the
General Assembly as follows:
SECTION 1. Title 27 of the General Laws entitled
"INSURANCE" is hereby amended
by adding thereto the following chapter:
CHAPTER
8.2
STOP-LOSS
INSURANCE
27-8.2-1.
Purpose and intent. -- This chapter shall be
known as the "Stop-Loss
Insurance Act." The purpose of this chapter is to establish criteria
for the issuance of stop-loss
insurance policies. Nothing in this chapter shall be construed
as imposing any requirement or
duty on any person other than an insurer, or as treating
any stop-loss policy as a direct policy of
health insurance.
27-8.2-2.
Definitions. -- (a) "Actuarial
certification" means a written statement by a
member of the
commissioner, that an insurer is in compliance with the provisions
of this chapter. The written
statement shall be based upon the individual’s examination, and
include a review of the
appropriate records and the actuarial assumptions and methods
used by the insurer in establishing
attachment points and other applicable determinations in
conjunction with the provision of stop-
loss insurance coverage.
(b) "Attachment
point" means the claims amount incurred by an insured group beyond
which the insurer incurs a liability for payment.
(c) "Expected
claims" means the amount of claims that, in the absence of a stop-loss
policy or other insurance, are projected to be incurred by
an insured group through its health plan.
27-8.2-3.
Stop-loss insurance coverage standards. -- (a) An insurer shall not issue a
stop-loss insurance policy that:
(1) Has an annual
attachment point for claims incurred per individual that is lower than
twenty thousand dollars ($20,000);
(2) Has an annual
aggregate attachment point that is lower than one hundred twenty
percent (120%) of expected claim; and
(3) Provides direct
coverage of health care expenses of an individual.
(b) The commissioner
may adopt rules that carry out the requirements of this chapter.
27-8.2-4.
Actuarial certification. -- An insurer shall
file with the commissioner annually
on or before March 15, an actuarial certification
certifying that the insurer is in compliance with
this chapter. The certification shall be in a form and
manner, and shall contain information,
specified by the commissioner. A copy of the certification
shall be retained by the insurer at its
principal place of business.
27-8.2-5.
Effective date. -- This chapter shall become effective
with respect to stop-loss
insurance policies issued or renewed on or after January 1,
2014.
SECTION 2. This act shall take effect upon passage.
=======
LC01305/SUB A
=======