Utah Code § 31A-43-301: Stop-loss insurance standards.

(1) A small employer stop-loss insurance contract shall:

(a) be issued to the small employer to provide insurance to the group health benefit plan, not the employees of the small employer;

(b) have a contract term with guaranteed rates for at least 12 months, without adjustment, unless there is a change in the benefits provided under the small employer's health plan during the contract period;

(c) include both a specific attachment point and an aggregate attachment point in a contract;

(d) align stop-loss plan benefit limitations and exclusions with a small employer's health plan benefit limitations and exclusions, including any annual or lifetime limits in the employer's health plan;

(e) subject to Subsection (4):

(i) have an annual specific attachment point that is at least $25,000; and

(ii) have an annual aggregate attachment point that may not be less than 90% of expected claims;

(f) pay stop-loss claims:

(i) incurred during the contract period; and

(ii) paid within 12 months after the expiration date of the contract; and

(g) include provisions to cover incurred and unpaid stop-loss claims when the small employer's stop-loss plan terminates.

(2) A small employer stop-loss insurance contract may not:

(a) include lasering; and

(b) pay claims directly to an individual employee, member, or participant.

(3) A stop-loss insurer or reinsurer:

(a) may enter into a small employer stop-loss insurance contract with a small employer with 10 or more enrolled employees; and

(b) may not enter into a small employer stop-loss insurance contract with a small employer with less than 10 enrolled employees.

(4) The provisions of this section do not apply to a small employer stop-loss insurance contract entered into before July 1, 2025, unless the insurance provider changes under the small employer's health plan during the contract period.