Chapter 415-H: Stop Loss Insurance

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 health insurance.

I. "Actuarial certification" means a written statement by a member of the American Academy of Actuaries, or other individual acceptable to the commissioner, that an insurer is in compliance with the provisions of this chapter, based upon the individual's examination and including 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.

II. "Attachment point" means the claims amount incurred by an insured group beyond which the insurer incurs a liability for payment.

III. "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.

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.

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.

The commissioner may adopt rules in accordance with RSA 541-A that carry out the requirements of this chapter and prescribe additional standards for stop loss insurance policies.