§ 4320 — Limitations on administrative services and stop-loss coverage

§ 4320. Limitations on administrative services and stop-loss coverage.\nNo insurer, subsidiary of an insurer, or controlled person of a holding\ncompany system may act as an administrator or claims paying agent, as\nopposed to an insurer, on behalf of a group which denies or limits\nbenefits for a specific disease or condition or for a procedure or\ntreatment unique to a specific disease or condition in a manner which\nwould be inconsistent with this chapter or regulations promulgated by\nthe superintendent had the group purchased insurance. No insurer,\nsubsidiary of an insurer, or controlled person of a holding company may\nprovide stop loss, catastrophic or reinsurance coverage to groups which\ndeny or limit benefits for a specific disease or condition or for a\nprocedure or treatment unique to a specific disease or condition in a\nmanner which would be inconsistent with this chapter or regulations\npromulgated by the superintendent had the group purchased insurance. A\nlimit, maximum, or other mechanism that controls total coverage without\nregard to a specific disease or condition shall not be deemed one that\ndenies or limits benefits for a specific disease or condition, or for a\nprocedure or treatment unique to a specific disease or condition.\nNothing herein shall be construed to mandate the inclusion of specified\nbenefits in an employer group plan, if such plan is not subject to the\nprovisions of this chapter.\n