Rule 120-2-50-.05 - Stop-Loss Coverage Requirements(1) A multiple employer self-insured health plan is required to obtain individual and aggregate excess stop-loss coverage from an insurer authorized to transact insurance in Georgia. Such coverage must be submitted for approval by the Commissioner.(2) Plan participants are required to find benefits up to the point at which the excess stop-loss insurer assumes one hundred percent of the liability to pay benefits. In reviewing an excess stop-loss agreement for approval, the Commissioner will closely scrutinize the agreement to determine whether the levels of individual and aggregate risk retained by the plan are such as will put the plan in an unsound condition or will render its proceedings hazardous to the public or to persons covered under the plan. In making his determination, the Commissioner will consider all relevant factors including, but not limited to, reserving practices, adequacy of employer/employee contributions, benefits provided under the plan, administrative and other expenses, and management. If the Commissioner is of the opinion that the excess stop-loss agreement will put the plan in an unsound condition, will render the plan's proceedings hazardous to the public or persons covered under the plan, or is otherwise not in compliance with the law, the Commissioner will disapprove the agreement.Ga. Comp. R. & Regs. R. 120-2-50-.05
O.C.G.A. Secs. 33-2-9, 33-50-5, 33-50-10.
Original Rule entitled "Step-Loss Coverage Requirements" adopted. F. Mar. 19, 1993; eff. Apr. 8, 1993.