CHAPTER 217
SB 283-FN – FINAL VERSION
02/02/06 0459s
02/02/06 0703s
12Apr2006… 1553h
2006 SESSION
01/09
SENATE BILL 283-FN
AN ACT relative to stop loss insurance.
SPONSORS: Sen. Flanders, Dist 7; Sen. Hassan, Dist 23; Sen. Martel, Dist 18; Rep. S. Francoeur, Rock 15
COMMITTEE: Banks and Insurance
This bill establishes a law governing stop loss insurance and provides minimums for such insurance.
This bill is a request of the insurance department.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
02/02/06 0459s
02/02/06 0703s
12Apr2006… 1553h
06-2340
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Six
AN ACT relative to stop loss insurance.
Be it Enacted by the Senate and House of Representatives in General Court convened:
217:1 New Chapter; Stop Loss Insurance. Amend RSA by inserting after chapter 415-G the following new chapter:
CHAPTER 415-H
415-H:1 Purpose and Intent. 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.
415-H:2 Definitions.
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.
415-H:3 Stop Loss Insurance Coverage Standards.
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.
415-H:4 Actuarial Certification. 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.
415-H:5 Rulemaking. 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.
217:2 Effective Date. This act shall take effect January 1, 2007.
Approved: June 1, 2006
Effective: January 1, 2007