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Current as of May 05, 2022 | Updated by FindLaw Staff
(1) A small employer stop-loss insurance contract shall:
(a) be issued to the small employer to provide insurance to the group health benefit plan, not the employees of the small employer;
(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;
(c) include both a specific attachment point and an aggregate attachment point in a contract;
(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;
(e) have an annual specific attachment point that is at least $10,000;
(f) have an annual aggregate attachment point that may not be less than 85% of expected claims;
(g) pay stop-loss claims:
(i) incurred during the contract period; and
(ii) paid within 12 months after the expiration date of the contract; and
(h) 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 contract shall not:
(a) include lasering; and
(b) pay claims directly to an individual employee, member, or participant.
Cite this article: FindLaw.com - Utah Code Title 31A. Insurance Code § 31A-43-301. Stop-loss insurance coverage standards - last updated May 05, 2022 | https://codes.findlaw.com/ut/title-31a-insurance-code/ut-code-sect-31a-43-301/
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 or via Westlaw before relying on it for your legal needs.
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