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Current as of January 01, 2025 | Updated by Findlaw Staff
(1) A self-insured health benefit plan established or maintained by a small employer, as defined in s. 627.6699(3)(v), is exempt from s. 627.6699 and may use a stop-loss insurance policy issued to the employer. For purposes of this subsection, the term “stop-loss insurance policy” means an insurance policy issued to a small employer which covers the small employer's obligation for the excess cost of medical care on an equivalent basis per employee provided under a self-insured health benefit plan.
(a) A small employer stop-loss insurance policy is considered a health insurance policy and is subject to s. 627.6699 if the policy has an aggregate attachment point that is lower than the greatest of:
1. Two thousand dollars multiplied by the number of employees;
2. One hundred twenty percent of expected claims, as determined by the stop-loss insurer in accordance with actuarial standards of practice; or
3. Twenty thousand dollars.
(b) Once claims under the small employer health benefit plan reach the aggregate attachment point set forth in paragraph (a), the stop-loss insurance policy authorized under this section must cover 100 percent of all claims that exceed the aggregate attachment point.
(2) A self-insured health benefit plan established or maintained by an employer with 51 or more covered employees is considered health insurance if the plan's stop-loss coverage, as defined in former s. 627.6482(14), has an aggregate attachment point that is lower than the greater of:
(a) One hundred ten percent of expected claims, as determined by the stop-loss insurer in accordance with actuarial standards of practice; or
(b) Twenty thousand dollars.
(3) Stop-loss insurance carriers shall use a consistent basis for determining the number of an employer's covered employees. Such basis may include, but is not limited to, the average number of employees employed annually or at a uniform time.
Cite this article: FindLaw.com - Florida Statutes Title XXXVII. Insurance § 627.66997. Stop-loss insurance - last updated January 01, 2025 | https://codes.findlaw.com/fl/title-xxxvii-insurance/fl-st-sect-627-66997/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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