Phia Group Media


Phia Group Media

SIIA State Legislative/Regulatory Update Report

On September 16, 2014
Exclusive Reporting for the Week of September 10, 2014

September 10, 2014 — This is your weekly update of state legislative/regulatory developments affecting companies involved in the self-insurance/alternative risk transfer marketplace. Should you have any questions on information provided in these reports and/or would like to alert SIIA to new state legislative/regulatory activity (health care, workers’ compensation and/or captive insurance matters) we may have missed, please contact Adam Brackemyre, Director of State Government Relations directly at 202/463-8161, or via e-mail at

Washington DC- Stop-Loss Legislation
An advocacy plan is taking shape in the District of Columbia to oppose harmful stop-loss legislation.

As part of this effort, SIIA will meet with DC Department of Insurance of Securities, Insurance and Banking (DISB) staff and City Council Members on the Business, Consumer and Regulatory Affairs Committee later this month to communicate industry concerns.

As previously reported, section seven of DC bill B20-0797 would effectively ban stop-loss in the small group market, require a $40,000 minimum individual attachment point and give the DISB commissioner the ability to increase individual and aggregate attachment points at his or her discretion.

NAIC- Stop Loss Paper is Available for Comment
The NAIC ERISA (B) Working Group’s stop-loss paper, available here, is still available for public comment. SIIA members are strongly encouraged to comment on the white paper. Several SIIA members requested a copy of the report last week.

SIIA convened its Government Relations Committee on Wednesday August, 27th and staff is drafting comments. All comments are due by September 16th, unless the NAIC extends the deadline.

If you need any assistance with submitting comments to the NAIC, please contact SIIA’s Director of State Government Relations, Adam Brackemyre, at or 202/595-0641.

Utah- Stop-Loss Law
Another SIIA member has been contacted by the Utah Department of Insurance (DOI), which is actively looking to make its state stop-loss law more attractive for stop-loss carriers.

The DOI is apparently researching why carriers are not selling in the small group market and may be making recommendations to the legislature to increase access to stop-loss insurance. SIIA expects to support such an initiative if it develops.

If your company has been contacted the Utah DOI staff, please let SIIA know so that we may better coordinate our efforts.

SIIA’s 34th Annual Conference
SIIA’s National Conference and Expo is scheduled for October 5-7, 2014 in Phoenix, AZ, which will feature a dedicated Legislative/Regulatory/Legal update session. Conference details, including registration forms, can be accessed on-line at, or by calling 800/851-7789.

Stop-Loss Battle Expands to Four States

On March 12, 2013
March 12, 2013 – Utah has become the fourth state that is considering legislation that would make it more difficult for employers to operate self-insured group health plans by restricting the availability of stop-loss insurance.

Known as the Small Employer Stop-Loss Insurer Act, HB 160 applies to groups with 50 or fewer employees. Unlike stop-loss legislation in California, Minnesota and Rhode Island, attachment point requirements in this bill are not onerous, but does contain a provision requiring stop-loss carriers to pay claims incurred but not reported if the plan terminates. The bill would also prohibit lasering.

Other provisions include:

  • Insurance Commissioner will create a standard stop loss application form for small groups
  • Policy must guarantee rates for 12 months – only exception is to price for a change in benefits of the Plan
  • Specific and aggregate coverage required
  • Requires the stop loss to provide gapless coverage
  • Minimum specific attachment point = $10,000
  • Minimum aggregate corridor = 90%
  • Contract basis no less favorable than 12/24
This is a developing story so please watch for further exclusive reporting from SIIA. The full text of HB 160, as well the other state stop-loss bills can be accessed on-line through the members’ only section of the association’s web site at Please contact SIIA Chief Operating Officer Mike Ferguson at 800/851-7789, or via e-mail at should you have any questions or would be interested in helping to oppose the legislation in Utah.