Stop-loss insurance 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) 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.