(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.
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