Section 415-H:3 Stop Loss Insurance Coverage Standards.
I. An insurer shall not issue or renew a stop loss insurance policy or certificate that:
(a) Has an annual attachment point for claims incurred per individual which is lower than $20,000;
(b) Has an annual aggregate attachment point, for groups of 50 or fewer, that is lower than the greater of:
(1) $4,000 times the number of group members;
(2) 120 percent of expected claims; or
(3) $20,000;
(c) Has an annual aggregate attachment point for groups of 51 or more that is lower than 110 percent of expected claims; or
(d) Provides direct coverage of health care expenses of an individual.
II. An insurer shall determine the number of persons in a group, for the purposes of this section, on a consistent basis, at least annually.
III. For the purposes of determining the dollar amounts set forth in paragraph I, and upon consideration of the medical components of the Consumer Price Index (CPI), the commissioner may amend these dollar amounts and shall publish any change in these dollar amounts at least 6 months prior to their effective dates.
Source. 2006, 217:1, eff. Jan. 1, 2007.