SECTION 13.567. Stop-Loss Insurance

(a) Minimum specific and aggregate coverage. The plan and trust must maintain specific and aggregate stop-loss insurance that is not less than the recommended minimum level included in the annual actuarial opinion required by §13.570(c)(2) of this title (relating to Financial Filing Requirements).

(b) Terms of contract for stop-loss insurance. The trustees, or an approved PEO acting on behalf of the trustees, must contract for stop-loss insurance in the name of and for the benefit of the plan and trust, as evidenced by a written commitment, binder, or policy for stop-loss insurance issued by an unaffiliated insurer authorized to do business in this state, which must include the following:

(1) no less than 30 days' notice to the commissioner of any amendment, cancellation, or nonrenewal of coverage;

(2) provide both specific and aggregate coverage with an aggregate retention of no more than 125 percent of the amount of expected claims for the subsequent plan year and the specific retention amount as determined by the actuarial opinion required by §13.570(c)(2) of this title;

(3) both the specific and aggregate coverage must require all claims to be submitted within 90 days after the claim is reported; and

(4) a requirement that the stop-loss carrier provide the trustees and the PEO any renewal quote at least 90 days before the expiration of the current policy.

(c) Request for waiver. The trustees, or an approved PEO acting on behalf of the trustees, may request in writing, including supporting documentation, that the commissioner waive or reduce the requirement for aggregate stop-loss insurance. The commissioner, after reviewing the request and documentation, and any additional information requested by and provided to TDI, will approve the request if the commissioner determines that the interests of the clients and participants are adequately protected.

Source Note: The provisions of this §13.567 adopted to be effective May 17, 2016, 41 TexReg 3479