Code of Vermont Rules › Agency 21 - DEPARTMENT OF FINANCIAL REGULATION › Sub-Agency 040 - DIVISION OF HEALTH CARE ADMINISTRATION › Chapter 024 - RULE H-2009-02 - HEALTH CARE STOP LOSS INSURANCE › Section 21 040 024 - RULE H-2009-02 - HEALTH CARE STOP LOSS INSURANCE

Current through June,
				2024
Section 1.
				Authority and Purpose.
This Rule is promulgated under the authority granted to the
				  Commissioner by Title
				  8 V.S.A. §
											15 and Title
				  8 V.S.A. §
											6015 in order to establish criteria for the
				  issuance of health care stop loss insurance policies and contracts. Nothing in
				  this Rule shall be construed as imposing any requirement or duty on any person
				  other than an insurer or as treating any health care stop loss policy as a
				  direct policy of health insurance.
Section 2. Scope.
This Rule applies to each health care stop loss insurance
				  policy or contract that is delivered or issued for delivery by an insurer in
				  Vermont.
Section 3.
				Definitions.
As used in this Rule:
A. "Actuarial Certification" means a written
				and signed statement by a member in good standing of the American Academy of
				Actuaries, or other individual acceptable to the Commissioner, that an insurer
				is in compliance with the provisions of this Rule, 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 health
				care stop loss insurance coverage.
B. "Attachment Point" means the claims amount
				incurred by a group health plan beyond which the health care stop loss insurer
				incurs a liability for payment.
C.
				"Commissioner" means the Commissioner of the Department of Financial
				Regulation.
D. "Department" means
				the Vermont Department of Financial Regulation.
E. "Expected Claims" means the amount of
				claims that, in the absence of a health care stop loss policy or other
				insurance, are projected to be incurred by a group health plan.
F. "Health Care Stop Loss Insurance" means
				insurance or other risk-transfer arrangement that is purchased by a group
				health plan or by the sponsor or trustee of such plan (or by any guarantor or
				indemnitor thereof other than a licensed insurance company or reinsurer), to
				limit the exposure of such person against losses sustained by such
				plan.
G. "Insurer" means any
				insurance company, including a captive insurance company formed or licensed
				under Chapter 141 of Title 8, Vermont Statutes Annotated (other than a pure
				captive), health maintenance organization, nonprofit hospital service
				corporation and nonprofit medical service corporation, and to the extent
				permitted by federal law, a risk retention group chartered and licensed in any
				state.
H. "Small Employer" has the
				same meaning provided in
				33 V.S.A.
				§
											1811(a)(3)(B), as
				amended and as may be amended from time to time. For purposes of determining
				whether an employer is a small employer under this regulation, this section
				shall apply to employers with employees in plans that are grand fathered under
				8 V.S.A. §
											4080g.