§ 40.1-24.6-7. Stop-loss coverage.
(a) The corporation established pursuant to this chapter for the purpose of providing healthcare costs for members’ employees, retirees, and other beneficiaries must participate in a group stop-loss policy provided by a licensed insurance company.
(b) The group stop-loss policy coverage will include a specific deductible stop-loss policy, and aggregate stop-loss coverage, both of which will apply to the corporation’s participating developmental disability agencies.
(c) Under the specific deductible stop-loss coverage, the licensed insurance carrier will assume liability beyond the specific deductible amount up to the limits of the policy.
(d) For the aggregate stop-loss coverage, the licensed insurance carrier will assume all of the claims threshold:
(1) Beyond one hundred and twenty percent (120%) of the expected claims for the policy year, up to the limits of the policy, or, if unavailable;
(2) Beyond a percentage rate that is consistent with marketplace standards for aggregate stop-loss insurance, but not to exceed one hundred and twenty-five percent (125%) of expected claims for the policy year.
(e) In addition to stop-loss policy coverage, the corporation must place in reserve an appropriate amount of money to cover the estimated cost of claims incurred, but unpaid, during the term of the policy or contract which shall be added to the expected claim level. The reserves for unpaid claims shall be in addition to monies reserved to cover the claims paid during the term of the policy, or contract for payment of healthcare costs for the employees, retirees, and other beneficiaries.
History of Section.
P.L. 2017, ch. 405, § 1; P.L. 2017, ch. 421, § 1.