§ 22:459 — Excess stop-loss coverage

§459. Excess stop-loss coverage
A. Each self-insurance plan shall include aggregate excess stop-loss coverage and
specific excess stop-loss coverage provided by an insurer licensed by the state of Louisiana.
Aggregate excess stop-loss coverage shall include provisions to cover incurred, unpaid
claims liability in the event of plan termination. A plan shall submit its proposed excess or
stop-loss insurance contract to the commissioner at least thirty days prior to the proposed
self-insurance plan's effective date and at least thirty days prior to any subsequent renewal
date. The commissioner shall review the contract to determine whether it meets the
standards established by this Section and shall respond within thirty days of its submission
to him. Any excess or stop-loss insurance plan must provide coverage with rates not subject
to adjustment by the insurer during the first twelve months.
B. The self-insurer shall possess a written commitment, binder, or policy for
stop-loss insurance issued by an insurer authorized to do business in this state and that the
commitment, binder, or policy provides all of the following items:
(1) At least thirty days' notice to the commissioner of any cancellation or nonrenewal
of coverage.
(2) Both specific and aggregate coverage with an aggregate retention of not more
than one-hundred twenty-five percent of the amount of expected claims for the next plan year
and a specific retention amount annually determined by the actuarial opinion required by R.S.
22:463(B).
(3) Both the specific and aggregate coverage required in Paragraph (2) of this
Subsection shall require all claims to be submitted within ninety days after the claim is
incurred and provide a twelve-month claims incurred period and at least a fifteen-month paid
claims period for each policy year.
C. On the application of a self-insurer, the commissioner may waive or reduce the
requirement for aggregate stop-loss insurance coverage required by this Section on a
determination that the interests of the participating employers and employees are adequately
protected based on the level of aggregate stop-loss insurance recommended by the actuary
as required by R.S. 22:463(B).

Legislative History

Acts 1984, No. 857, §1; Acts 1990, No. 902, §1; Redesignated from R.S. 22:3009 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2012, No. 680, §1, eff. June 7, 2012; Acts 2015, No. 455, §1.