Reference is to the bill as introduced.
Amend the bill, as and if amended, by deleting all after the enacting words and inserting:
/ SECTION 1. Chapter 41, Title 38 of the 1976 Code is amended by adding:
"Section 38-41-35.
Each participating employer, as a condition of
participation in a multiple employer self-insured health plan,
shall execute an agreement by which the employer agrees to
personally pay all claims for benefits covered under the
multiple employer self-insured health plan which are incurred by
his or its covered employees and their covered dependents, but
which the plan has failed to pay. Such agreements shall be made
on forms prescribed by the director and shall extend to all
unpaid claims for benefits incurred by the employer's employees
and their dependents during the time such employees and
dependents were covered under the multiple employer self-insured
health plan. Neither failure of a participating employer to
execute an agreement, nor failure of the plan to require such
execution, shall excuse the employer from liability for unpaid
claims incurred by covered employees and dependents. An
employer shall be deemed to have notice of the requirements of
this section, and upon joining a multiple employer self-insured
health plan, the employer shall be deemed to have agreed to
liability for unpaid claims of his covered employees and their
dependents in the same manner as if an agreement had been
executed.
The multiple employer self-insured health
plan shall provide each participating employer annual notice of
the participating employer's responsibilities. This notice shall
be in a form approved by the director or his designee and shall
state that the participating employer is responsible for all
claims incurred by the participating employer's covered
employees and their covered dependents that the multiple
employer self-insured health plan has failed to pay. The
multiple employer self-insured health plan must obtain written
certification from each participating employer annually that the
participating employer understands that it is liable for covered
claims which the multiple employer self-insured health plan
fails to pay. The multiple employer self-insured health plan
shall file an affidavit signed by the multiple employer
self-insured health plan's Chief Executive Officer that it has
obtained each participating employer's certification. The
multiple employer self-insured health plan shall maintain copies
of each participating employer's annual certification for the
duration of the multiple employer self-insured health plan.
Failure of the multiple employer self-insured health plan to
comply with any of its obligations under this section shall not
be a defense to, or in any way diminish, an employer's
obligation to personally pay all claims for benefits covered
under the multiple employer self-insured health plan which are
incurred by his or its covered employees and their covered
dependents, but which the plan has failed to pay."
SECTION 2. Section 38-41-50 of the 1976 Code, as last amended by Act 137 of 2012, is further amended to read:
"Section 38-41-50.
A multiple employer self-insured health plan shall include
aggregate excess stop-loss coverage and individual excess
stop-loss coverage provided by an insurer licensed, approved, or
eligible by the State. A MEWA shall maintain excess insurance
coverage written by an insurer that the Department of Insurance
considers approved or eligible to do business in this State.
This coverage must have a net retention level determined in
accordance with sound actuarial principles approved by the
director or his designee, and based on the number of risks
insured by the MEWA. The MEWA must file the policy contract
providing this coverage with the director or his designee. The
terms of this policy contract must require that before the
insurer may cancel or modify the terms of this policy contract,
the insurer must give notice of the pending cancellation or
modification of terms to the director at least thirty days
before the cancellation or modification may occur. Aggregate
excess stop-loss coverage shall include provisions to cover
incurred, unpaid claim liability in the event of plan
termination. The excess or stop-loss insurer shall bear the
risk of coverage for any member of the pool that becomes
insolvent with outstanding contributions due. In
addition, the plan The limits required for an excess
stop-loss policy shall have a be
determined by the director or his designee in accordance with
sound actuarial principles, so that the probability of incurred
claims exceeding the participating
employer's employers' fund in an
amount at least equal to the point at which and
the aggregate limit of the excess or stop-loss
insurer shall assume one hundred percent of additional
liability coverage is de minimus. A plan shall
submit its proposed excess or stop-loss insurance contract to
the director or his designee at least thirty days prior to the
proposed plan's contract's effective
date and at least thirty days subsequent
prior to any renewal date. The director or his designee
shall review the contract to determine whether it meets the
standards established by this chapter and respond within a
thirty-day period. In reviewing an excess stop-loss
agreement for approval, the director or his designee will
closely scrutinize the agreement to determine whether the levels
of individual and aggregate risk retained by the plan will put
the plan in an unsound condition or will render its proceedings
hazardous to the public or to persons covered under the
plan. Any excess or stop-loss insurance
plan contract must be noncancellable for
a minimum term of two years. In addition, the plan shall
have a participating employer's fund in an amount at least equal
to the point at which the excess or stop-loss insurer shall
assume a one hundred percent share of additional liability. The
amount required for the employer's fund must be determined in
accordance with sound actuarial principles and approved by the
director or his designee and based upon the number of risk
insured by the plan. This employer's fund must be funded via
cash or cash equivalent securities."
SECTION 3. This act takes effect upon approval by the Governor. /
Renumber sections to conform.
Amend title to conform.