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This entry was published on 2015-01-23
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SECTION 4237-A
Stop-loss insurance
Insurance (ISC) CHAPTER 28, ARTICLE 42
§ 4237-a. Stop-loss insurance. (a) An insurer authorized to do the
business of accident and health insurance in this state and a health
service corporation organized under article forty-three of this chapter
shall be authorized to issue stop-loss insurance as provided in this
section.

(b) "Stop-loss insurance" means an insurance policy whereby the
insurer agrees to pay claims or indemnify an employer for losses
incurred under a self-insured employee benefit plan or a student health
plan as authorized by section one thousand one hundred twenty-four of
this chapter in excess of specified loss limits for individual claims
and/or for all claims combined, or any similar arrangement.

(c) A stop-loss insurance policy delivered, issued for delivery, or
entered into in this state shall clearly describe:

(1) the entire money or other consideration for the policy;

(2) the time at which the insurance takes effect and terminates;

(3) the specified per-claim, per-employee or, in the case of a student
health plan under section one thousand one hundred twenty-four of this
chapter, per student, or aggregate amount of claims above which payment
or reimbursement is to be made by the insurer; and

(4) the payments to be made by the insurer once the specified
stop-loss thresholds have been exceeded.

(d) No stop-loss insurance contract shall be issued or renewed if
issuance of the policy would be prohibited by section two thousand six
hundred thirteen, three thousand two hundred thirty-one, four thousand
three hundred seventeen or four thousand three hundred twenty of this
chapter.

(e) The superintendent may promulgate such rules and regulations he
deems necessary or desirable to establish financial requirements and
standards for the form and content of stop-loss insurance policies
authorized by this section.