For the purposes of this chapter, the term:
(1) “Aggregate attachment point” means the total amount of health claims incurred by a small employer in a policy year for all covered employees and their dependents, and covered by a stop-loss insurance policy, above which the stop-loss insurer incurs a liability for payment under aggregate stop-loss coverage.
(2) “Attachment point” means the claims amount incurred by an insured group beyond which the insurer incurs a liability for payment.
(3) “Commissioner” means the Commissioner of the Department of Insurance, Securities and Banking.
(4) “Expected claims” means the total amount of claims that, in the absence of medical stop-loss insurance, are projected to be incurred by the insured using reasonable and accepted actuarial principles in a policy year.
(5) “Individual attachment point” means the amount of health claims incurred by a small employer in a policy year for an individual employee or dependent of an employee, and covered by a stop-loss insurance policy, above which the stop-loss insurer incurs a liability for payment, under individual stop-loss coverage.
(6) “Stop-loss insurance” means coverage that insures an employer or an employer-sponsored health plan against the risk that:
(A) One claim will exceed a specific dollar amount; or
(B) The entire loss of a self-insurance plan will exceed a specific dollar amount.
(May 2, 2015, D.C. Law 20-265, § 201, 62 DCR 1529.)
Structure District of Columbia Code