Utah HB 385: Insurance Revisions

Bill Text

01-31 10:54 H.B. 385
1 Insurance Revisions
2025 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: James A. Dunnigan
Senate Sponsor:
2

3 LONG TITLE
4 General Description:
5 This bill addresses stop-loss insurance.
6 Highlighted Provisions:
7 This bill:
8 ▸ modifies the requirements for a small employer stop-loss insurance contract;
9 ▸ regulates with which small employers a stop-loss insurer or reinsurer may enter stop-loss
10 insurance contracts;
11 ▸ provides a transition period for existing small employer stop-loss insurance contracts; and
12 ▸ makes technical and conforming changes.
13 Money Appropriated in this Bill:
14 None
15 Other Special Clauses:
16 This bill provides a special effective date.
17 Utah Code Sections Affected:
18 AMENDS:
19 31A-43-301, as last amended by Laws of Utah 2015, Chapter 244
20

21 Be it enacted by the Legislature of the state of Utah:
22 Section 1. Section 31A-43-301 is amended to read:
23 31A-43-301 . Stop-loss insurance standards.
24 (1) A small employer stop-loss insurance contract shall:
25 (a) be issued to the small employer to provide insurance to the group health benefit plan,
26 not the employees of the small employer;
27 (b) have a contract term with guaranteed rates for at least 12 months, without
28 adjustment, unless there is a change in the benefits provided under the small
29 employer's health plan during the contract period;
30 (c) include both a specific attachment point and an aggregate attachment point in a
H.B. 385

H.B. 385 01-31 10:54
31 contract;
32 (d) align stop-loss plan benefit limitations and exclusions with a small employer's health
33 plan benefit limitations and exclusions, including any annual or lifetime limits in the
34 employer's health plan;
35 (e) subject to Subsection (4):
36 (i) have an annual specific attachment point that is at least [$10,000] $30,000; and
37 [(f)] (ii) have an annual aggregate attachment point that may not be less than [85%]
38 90% of expected claims;
39 [(g)] (f) pay stop-loss claims:
40 (i) incurred during the contract period; and
41 (ii) paid within 12 months after the expiration date of the contract; and
42 [(h)] (g) include provisions to cover incurred and unpaid stop-loss claims when the small
43 employer's stop-loss plan terminates.
44 (2) A small employer stop-loss insurance contract [shall] may not:
45 (a) include lasering; and
46 (b) pay claims directly to an individual employee, member, or participant.
47 (3) A stop-loss insurer or reinsurer:
48 (a) may enter into a small employer stop-loss insurance contract with a small employer
49 with 15 or more enrolled employees; and
50 (b) may not enter into a small employer stop-loss insurance contract with a small
51 employer with less than 15 enrolled employees.
52 (4) A small employer stop-loss insurance contract issued before July 1, 2025, that is
53 renewed with the same stop-loss insurer or reinsurer that executed that small employer
54 stop-loss insurance contract shall comply with Subsection (1)(e) by no later than July 1,
55 2027.
56 Section 2. Effective Date.
57 This bill takes effect on July 1, 2025.
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