{"data":{"id":"us-ut/utah-code-31a-43-301","jurisdiction":"us-ut","citation":"Utah Code § 31A-43-301","heading":"Stop-loss insurance standards.","body":"(1) A small employer stop-loss insurance contract shall:\n(a) be issued to the small employer to provide insurance to the group health benefit plan, not the employees of the small employer;\n(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;\n(c) include both a specific attachment point and an aggregate attachment point in a contract;\n(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;\n(e) subject to Subsection (4):\n(i) have an annual specific attachment point that is at least $25,000; and\n(ii) have an annual aggregate attachment point that may not be less than 90% of expected claims;\n(f) pay stop-loss claims:\n(i) incurred during the contract period; and\n(ii) paid within 12 months after the expiration date of the contract; and\n(g) include provisions to cover incurred and unpaid stop-loss claims when the small employer's stop-loss plan terminates.\n(2) A small employer stop-loss insurance contract may not:\n(a) include lasering; and\n(b) pay claims directly to an individual employee, member, or participant.\n(3) A stop-loss insurer or reinsurer:\n(a) may enter into a small employer stop-loss insurance contract with a small employer with 10 or more enrolled employees; and\n(b) may not enter into a small employer stop-loss insurance contract with a small employer with less than 10 enrolled employees.\n(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.","path":["Title 31A Insurance Code","Chapter 31A-43 Small Employer Stop-Loss Insurance Act","Part 31A-43-3 Stop-Loss Insurance"],"source_url":"https://le.utah.gov/xcode/Title31A/Chapter43/31A-43-S301.html","current_through":"2026 General Session","vintage":"","retrieved_at":"2026-09-03T11:34:33Z","sha256":"fdd76b6e1860030864ddfd94973d490d6f366c222137668ca91ee0b77721f6aa","source_id":"us-ut","stale":false,"prev":"us-ut/utah-code-31a-43-202","next":"us-ut/utah-code-31a-43-302"},"notice":"GroundRules: Original legal text. Not legal advice."}