July 14, 2015
On July 8, 2015, Insurance Commissioner Wade issued Bulletin HC-103 to be read in conjunction with Bulletin HC-95 dated Mar. 17, 2014. The bulletin provides guidance on provisions that will not be approved in a stop-loss policy issued by an accident and health insurer, which insures the employer or its group health plan and not the enrollees covered by the plan. Policies issued or renewed on or after Jan. 1, 2016 may not contain the following provisions:
Mid-term rate increases at the discretion of the carrierEarly termination at the discretion of the carrier other than in accordance with the cancellation and nonrenewal lawsRescissions for reasons other than fraud or intentional misrepresentationAnnual dollar limitations in coverageRequirements that enrollees be actively at workMandated provider networksCase management requirementsDifferences in attachment points based on the health status of the insured
Employers who sponsor a self-insured plan with stop-loss coverage should review their stop-loss contract and work with their attorney and carrier to remove such provisions.
Bulletin No. HC-103 »