LAC 37:XIII.16917. Additional Requirements for Stop-Loss or Excess Insurance

A. Stop loss or excess insurance issued to a self-insurance plan must meet the following requirements. 1. The plan must include a provision stating that aggregate stop-loss or excess coverage and specific stop-loss or excess coverage may only be provided by an insurer licensed to do business in the state of Louisiana. 2. The stop-loss or excess policies must contain provisions to cover incurred, unpaid claims liability in the event of plan termination. 3. The stop-loss or excess insurer shall bear the risk of coverage for any employer participating in the self-insurance plan that becomes insolvent with outstanding contributions due. 4. The stop-loss or excess insurer shall provide coverage with rates not subject to adjustment by the stop-loss or excess insurer during the first 12 months of coverage, unless: a. there is a change in the benefits provided under the group health plan; and/or b. enrollment under the group health plan changes by at least 10 percent. 5. A stop loss or excess insurer must submit its proposed stop-loss or excess policy to the Commissioner of the Department of Insurance for review at least 30 days prior to the proposed self-insurance plan’s effective date and at least 30 days prior to any subsequent renewal date.