(a) (1) In this section the following words have the meanings indicated.

(2) “Aggregate attachment point” means the percentage of expected claims in a policy year above which the medical stop-loss insurer assumes all or part of the liability for losses incurred by the insured.

(3) “Carrier” means:

(i) an insurer; or

(ii) a nonprofit health service plan.

(4) “Expected claims” means the 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.

(5) “Medical stop-loss insurance” means insurance, other than reinsurance, that is purchased by a person, other than a carrier or a health care provider, to protect the person against catastrophic, excess, or unexpected losses incurred by that person’s obligations to third parties under the terms of a health benefit plan.

(6) “Medical stop-loss insurer” means a carrier that is authorized to sell, issue, and deliver policies of medical stop-loss insurance in the State.

(7) “Small employer” has the meaning stated in § 31-101 of this article.

(8) “Specific attachment point” means the dollar amount in losses attributable to a single individual in a policy year beyond which the medical stop-loss insurer assumes all or part of the liability for losses incurred by the insured.

(b) Subject to subsection (d)(2) of this section, this section applies to each medical stop-loss insurer and each medical stop-loss insurance policy or contract that is delivered or issued for delivery in the State.

(c) Medical stop-loss insurance may only be sold, issued, or delivered in the State by a carrier that holds a certificate of authority issued by the Commissioner that authorizes the carrier to engage in the business of health insurance or to act as a nonprofit health service plan.

(d) (1) Except as provided in paragraph (2) of this subsection, a medical stop-loss insurer may not issue, renew, deliver, or offer a policy or contract of medical stop-loss insurance, if the policy or contract has:

(i) a specific attachment point of less than $22,500; or

(ii) an aggregate attachment point of less than 120% of expected claims.

(2) This subsection does not apply to:

(i) a policy or contract of medical stop-loss insurance issued or delivered before June 1, 2015, if the policy or contract maintains:

1. a specific attachment point of no less than $10,000; and

2. an aggregate attachment point of no less than 115% of expected claims;

(ii) a renewal of a policy or contract described in item (i) of this paragraph; or

(iii) a policy or contract of medical stop-loss insurance issued or delivered on or after June 1, 2015, if the policy or contract:

1. is issued or delivered to an employer that on May 31, 2015, held a policy or contract of medical stop-loss insurance with:

A. a specific attachment point of not less than $10,000; and

B. an aggregate attachment point of not less than 115% of expected claims; and

2. maintains:

A. a specific attachment point of not less than $10,000; and

B. an aggregate attachment point of not less than 115% of expected claims.

(e) For a stop-loss insurance policy or contract issued to a small employer, a medical stop-loss insurer may not:

(1) (i) impose higher cost sharing for a specific individual within a small employer’s health benefit plan than is required for other individuals within the small employer’s health benefit plan; or

(ii) decrease or remove stop-loss coverage for a specific individual within a small employer’s health benefit plan; or

(2) exclude any employee or dependent from a policy or contract on the basis of an actual or expected health status-related factor or condition, including:

(i) physical or behavioral health, including mental illness or substance use disorder;

(ii) claims experience;

(iii) medical history;

(iv) receipt of health care;

(v) genetic information;

(vi) disability;

(vii) evidence of insurability, including conditions arising out of acts of domestic violence against an employee or dependent; or

(viii) any other health status-related factor as determined by the Commissioner.

(f) For a stop-loss insurance policy or contract issued to a small employer, a medical stop-loss insurer shall:

(1) guarantee rates for at least 12 months, without adjustment, unless there is a change in:

(i) the benefits provided under the small employer’s health benefit plan during the policy or contract period;

(ii) the ownership and control of the small employer; or

(iii) the number of covered lives by a significant percentage resulting from an event such as an acquisition or a divestiture;

(2) pay stop-loss claims incurred during the policy or contract period and submitted within 12 months after the expiration date of the policy or contract; and

(3) disclose to the small employer, in a form and manner approved by the Commissioner and before entering into a policy or contract for medical stop-loss insurance:

(i) the total costs of the policy or contract;

(ii) 1. the dates on which the policy or contract takes effect and terminates; and

2. provisions for renewing the policy or contract;

(iii) the aggregate attachment point and the specific attachment point for the policy or contract; and

(iv) any limitations on coverage.

(g) A medical stop-loss insurer who offers or issues a medical stop-loss insurance policy or contract that does not meet the requirements of this section shall be subject to the sanctions set forth in § 4-113 of this article for authorized insurers and § 4-212 of this article for unauthorized insurers.

(h) Nothing in this section shall be construed as:

(1) imposing any requirement or duty on any person other than a carrier; or

(2) treating any medical stop-loss insurance policy as a policy of individual, group, or blanket health insurance covering the participants in the underlying health benefit plan.