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Stop-loss draft authors want paid claims data

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The state regulators who are working on a white paper about stop-loss insurance wish they had more information about stop-loss claim payments.

The regulators talk about their hunger for stop-loss claims data in a new draft of the paper.

The Employee Retirement Income Security Act (ERISA) Working Group, part of the National Association of Insurance Commissioners (NAIC), is developing the paper because of concerns that the NAIC’s current stop-loss models may be outmoded, and that small businesses may use very small stop-loss arrangements to evade Patient Protection and Affordable Care Act (PPACA) small-group coverage requirements.

See also: The new PPACA stop-loss guidance: What agents should know.

PPACA applies some coverage requirements to self-insured plans but exempts the plans from others.

In the new draft, the drafters note at one point that owners of small businesses may not know much about stop-loss insurance and may need extra help with understanding how stop-loss plans can differ from ordinary small-group health insurance policies.

Later in the draft, the drafters say they would like to see states collect data on the stop-loss market. 

“Basic data collection on premiums and claims paid, possibly in categories related to group size, could provide states with valuable information about the market,” the drafters say.

They note that Colorado collects information about premiums, broken down by group size, but no information about claims paid, and that Missouri collects information both about premiums and claims, but not broken down by group size.

The drafters suggest that Congress could deal with concerns about stop-loss-related antiselection by requiring stop-loss providers to sell small stop-loss plans on a guaranteed-issue basis, just as they require insurers to sell fully insured small-group coverage on a guaranteed-issue basis.

See also: Stop-loss draft warns of coverage twists