31A-43-301. Stop-loss insurance standards.
(1) A small employer stop-loss insurance contract shall: be issued to the small employer to provide insurance to the group health benefit plan, not the employees of the small employer; 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; include both a specific attachment point and an aggregate attachment point in a contract; 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; subject to Subsection: (4) have an annual specific attachment point that is at least $25,000; and have an annual aggregate attachment point that may not be less than 90% of expected claims; pay stop-loss claims: incurred during the contract period; and paid within 12 months after the expiration date of the contract; and 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: include lasering; and pay claims directly to an individual employee, member, or participant.
(3) A stop-loss insurer or reinsurer: may enter into a small employer stop-loss insurance contract with a small employer with 10 or more enrolled employees; and 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.