2013 -- H 5459 SUBSTITUTE A
A N A C T
RELATING TO INSURANCE
Introduced By: Representatives Finn, and Edwards
Date Introduced: February 14, 2013
It is enacted by the General Assembly as follows:
SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended
by adding thereto the following chapter:
27-8.2-1. Purpose and intent. -- This chapter shall be known as the "Stop-Loss
Insurance Act." The purpose of this chapter is to establish criteria for the issuance of stop-loss
insurance policies. Nothing in this chapter shall be construed as imposing any requirement or
duty on any person other than an insurer, or as treating any stop-loss policy as a direct policy of
27-8.2-2. Definitions. -- (a) "Actuarial certification" means a written statement by a
member of the
commissioner, that an insurer is in compliance with the provisions of this chapter. The written
statement shall be based upon the individualís examination, and include a review of the
appropriate records and the actuarial assumptions and methods used by the insurer in establishing
attachment points and other applicable determinations in conjunction with the provision of stop-
loss insurance coverage.
(b) "Attachment point" means the claims amount incurred by an insured group beyond
which the insurer incurs a liability for payment.
(c) "Expected claims" means the amount of claims that, in the absence of a stop-loss
policy or other insurance, are projected to be incurred by an insured group through its health plan.
27-8.2-3. Stop-loss insurance coverage standards. -- (a) An insurer shall not issue a
stop-loss insurance policy that:
(1) Has an annual attachment point for claims incurred per individual that is lower than
twenty thousand dollars ($20,000);
(2) Has an annual aggregate attachment point that is lower than one hundred twenty
percent (120%) of expected claim; and
(3) Provides direct coverage of health care expenses of an individual.
(b) The commissioner may adopt rules that carry out the requirements of this chapter.
27-8.2-4. Actuarial certification. -- An insurer shall file with the commissioner annually
on or before March 15, an actuarial certification certifying that the insurer is in compliance with
this chapter. The certification shall be in a form and manner, and shall contain information,
specified by the commissioner. A copy of the certification shall be retained by the insurer at its
principal place of business.
27-8.2-5. Effective date. -- This chapter shall become effective with respect to stop-loss
insurance policies issued or renewed on or after January 1, 2014.
SECTION 2. This act shall take effect upon passage.