(a) An insurance company licensed under AS 21.09, a hospital or medical service corporation licensed under AS 21.87, a fraternal benefit society licensed under AS 21.84, a health maintenance organization licensed under AS 21.86, or a multiple employer welfare arrangement may not issue a stop-loss insurance policy that
(1) has an annual attachment point for claims incurred for each individual that is lower than $10,000;
(2) has an annual aggregate attachment point for a small employer that is lower than the greatest of
(A) $4,000 times the number of individuals covered under the health benefit plan;
(B) 120 percent of the expected claims for the health benefit plan for the period covered by the stop-loss insurance policy; or
(C) $20,000;
(3) has an annual aggregate attachment point for a large employer that is lower than 110 percent of expected claims for the health benefit plan for the period covered by the stop-loss insurance policy; or
(4) provides direct coverage of health care expenses of an individual.
(b) The director may, by regulation, change the dollar amounts established under (a) of this section to reflect medical costs in this state, including adjustments to reflect changes in the medical care component of the Consumer Price Index for all urban consumers for the Anchorage Metropolitan Area compiled by the Bureau of Labor Statistics, United States Department of Labor.
(c) For the purposes of this section,
(1) “attachment point” means the claim amount incurred by an insured group beyond which the insurer incurs a liability for payment;
(2) “expected claims” means the amount of claims that, in absence of a stop-loss insurance policy or other insurance, are projected to be incurred by an insured group through its health benefit plan;
(3) “health benefit plan” has the meaning given in AS 21.54.500;
(4) “large employer” has the meaning given in AS 21.54.500;
(5) “small employer” has the meaning given in AS 21.54.500.
Structure Alaska Statutes
Chapter 42. The Insurance Contract
Article 1. The Insurance Contract.
Sec. 21.42.010. Applicability.
Sec. 21.42.020. Insurable interest: life, annuity, or health.
Sec. 21.42.030. Insurable interest: property.
Sec. 21.42.040. Interest of named insured.
Sec. 21.42.050. Change of interest on death.
Sec. 21.42.060. Transfer of interest between joint insureds.
Sec. 21.42.070. Insurance without interest, or of wager, is void.
Sec. 21.42.075. Reimbursement of losses.
Sec. 21.42.080. Capacity to contract.
Sec. 21.42.090. Application required, life and health insurance.
Sec. 21.42.100. Request for copy of application; alteration.
Sec. 21.42.110. Representations in applications.
Sec. 21.42.120. Filing, approval of forms.
Sec. 21.42.123. Form filing subject to prior approval.
Sec. 21.42.125. Form filing subject to file and use; penalties.
Sec. 21.42.130. Grounds for disapproval.
Sec. 21.42.140. Standard provisions.
Sec. 21.42.145. Stop-loss insurance provisions.
Sec. 21.42.150. Policy must contain entire contract.
Sec. 21.42.160. Contents of policies in general.
Sec. 21.42.170. Additional policy contents.
Sec. 21.42.175. Non-English translations.
Sec. 21.42.180. Charter, bylaw provisions.
Sec. 21.42.190. Execution of policies.
Sec. 21.42.200. Underwriters' and combination policies.
Sec. 21.42.205. Coordination of benefits.
Sec. 21.42.210. Interest in reinsurance.
Sec. 21.42.220. Validity of noncomplying forms.
Sec. 21.42.230. Construction of policies.
Sec. 21.42.250. Delivery or posting of policy; notifications.
Sec. 21.42.260. Renewal by certificate.
Sec. 21.42.265. Effective date of coverage.
Sec. 21.42.270. Assignment of policies.
Sec. 21.42.280. Payment discharges insurer.
Sec. 21.42.290. Minor may give acquittance.
Sec. 21.42.300. Forms for proof of loss to be furnished.