NAC695B.250. General provisions.

     1. An insurer shall not issue a policy for stop-loss insurance for a hospital, medical or dental service plan subject to the provisions of this chapter and chapter 695B of NRS if the policy for stop-loss insurance:

     (a) Has an annual attachment point for claims incurred per individual that is lower than $10,000;

     (b) Has an annual aggregate attachment point for groups of not more than 50 persons that is lower than the greater of:

          (1) The number of group members times $4,000;

          (2) One hundred and twenty percent of expected claims; or

          (3) Ten thousand dollars;

     (c) Has an annual aggregate attachment point for groups of more than 50 persons that is lower than 110 percent of expected claims; or

     (d) Provides direct coverage of health care expenses of an individual.

     2. For the purposes of this section, an insurer shall determine the number of persons in a group on a consistent basis at least annually.

     3. If a policy for stop-loss insurance for a hospital, medical or dental service plan does not meet the criteria set forth in this section, the policy will be deemed to be a health benefit plan for the purposes of this chapter and chapter 695B of NRS.

     4. As used in this section:

     (a) “Attachment point” means the amount of claims incurred by an insured group beyond which an insurer incurs a liability for payment.

     (b) “Expected claims” means the amount of claims that, in the absence of a stop-loss policy or other insurance, are projected to be incurred by an insured group through its health plan.

     (c) “Stop-loss insurance” means insurance purchased by an employer to limit exposure to claim expenses under a health benefit plan provided by the employer.

     (Added to NAC by Comm’r of Insurance by R113-00, eff. 3-30-2001)