2013 Maryland Code
§ 15-129 - Stop-loss insurance policies

MD Ins Code § 15-129 (2013) What's This?


(a) (1) In this section the following words have the meanings indicated.

(2) “Aggregate attachment point” means the percentage of expected claims in a policy year above which the medical stop-loss insurer assumes all or part of the liability for losses incurred by the insured.

(3) “Carrier” means:

(i) an insurer; or

(ii) a nonprofit health service plan.

(4) “Expected claims” means the amount of claims that, in the absence of medical stop-loss insurance, are projected to be incurred by the insured using reasonable and accepted actuarial principles.

(5) “Medical stop-loss insurance” means insurance, other than reinsurance, that is purchased by a person, other than a carrier or a health care provider, to protect the person against catastrophic, excess, or unexpected losses incurred by that person’s obligations to third parties under the terms of a health benefit plan.

(6) “Medical stop-loss insurer” means a carrier that is authorized to sell, issue, and deliver policies of medical stop-loss insurance in the State.

(7) “Specific attachment point” means the dollar amount in losses attributable to a single individual in a policy year beyond which the medical stop-loss insurer assumes all or part of the liability for losses incurred by the insured.

(b) This section applies to each medical stop-loss insurer and each medical stop-loss insurance policy or contract that is delivered or issued for delivery in the State.

(c) Medical stop-loss insurance may only be sold, issued, or delivered in the State by a carrier that holds a certificate of authority issued by the Commissioner that authorizes the carrier to engage in the business of health insurance or to act as a nonprofit health service plan.

(d) A medical stop-loss insurer may not issue, deliver, or offer a policy or contract of medical stop-loss insurance, if the policy has:

(1) a specific attachment point of less than $10,000; or

(2) an aggregate attachment point of less than 115% of expected claims.

(e) A medical stop-loss insurer who offers or issues a medical stop-loss insurance policy that does not meet the requirements of this section shall be subject to the sanctions set forth in § 4-113 of this article for authorized insurers and § 4-212 of this article for unauthorized insurers.

(f) Nothing in this section shall be construed as:

(1) imposing any requirement or duty on any person other than a carrier; or

(2) treating any medical stop-loss insurance policy as a policy of individual, group, or blanket health insurance covering the participants in the underlying health benefit plan.

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