28 Tex. Admin. Code § 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.
Notes
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