Utah Code § 31A-43-301 Stop-loss insurance standards.
31A-43-301. Stop-loss insurance standards.
(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) subject to Subsection (4):
(i) have an annual specific attachment point that is at least $25,000; and
(ii) have an annual aggregate attachment point that may not be less than 90% of expected claims;
(f) pay stop-loss claims:
(i) incurred during the contract period; and
(ii) paid within 12 months after the expiration date of the contract; and
(g) 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 insurance contract may not:
(a) include lasering; and
(b) pay claims directly to an individual employee, member, or participant.
(3) A stop-loss insurer or reinsurer:
(a) may enter into a small employer stop-loss insurance contract with a small employer with 10 or more enrolled employees; and
(b) may not enter into a small employer stop-loss insurance contract with a small employer with less than 10 enrolled employees.
(4) The provisions of this section do not apply to a small employer stop-loss insurance contract entered into before July 1, 2025, unless the insurance provider changes under the small employer's health plan during the contract period.
Amended by Chapter 175, 2025 General Session