For the purposes of this chapter, the term: “Aggregate attachment point” means the total amount of health claims incurred by a small employer in a policy year for all covered employees and their dependents, and covered by a stop-loss insurance policy, above which the stop-loss insurer incurs a liability for payment under aggregate stop-loss coverage. “Attachment point” means the claims amount incurred by an insured group beyond which the insurer incurs a liability for payment. “Commissioner” means the Commissioner of the Department of Insurance, Securities and Banking. “Expected claims” means the total 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 in a policy year. “Individual attachment point” means the amount of health claims incurred by a small employer in a policy year for an individual employee or dependent of an employee, and covered by a stop-loss insurance policy, above which the stop-loss insurer incurs a liability for payment, under individual stop-loss coverage. “Stop-loss insurance” means coverage that insures an employer or an employer-sponsored health plan against the risk that: One claim will exceed a specific dollar amount; or The entire loss of a self-insurance plan will exceed a specific dollar amount.
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