(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.
(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
(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.
(a) include lasering; and
(b) pay claims directly to an individual employee, member, or participant.
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