Utah § 31A-43-301 Stop-loss insurance standards.

Utah Statutes

§ 31A-43-301 — Stop-loss insurance standards.

Utah·Title 31A Insurance Code·Ch. 31A-43 Small Employer Stop-Loss Insurance Act·Part 31A-43-3 Stop-Loss Insurance

(1)A small employer stop-loss insurance contract shall:

(1)(a) be issued to the small employer to provide insurance to the group health benefit plan, not the employees of the small employer;

(1)(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;

(1)(c) include both a specific attachment point and an aggregate attachment point in a contract;

(1)(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;

(1)(e) subject to Subsection (4):

(1)(e)(i) have an annual specific attachment point that is a

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