Bill > S218

This bill modifies North Carolina's regulations for stop loss insurance for small employers by lowering the minimum number of eligible employees from 12 to 5, which would allow smaller businesses to access stop loss coverage. Stop loss insurance is a type of policy that protects employers who self-fund their health insurance by reimbursing them for medical claims that exceed a predetermined threshold. The bill maintains existing provisions that require stop loss insurance policies to have specific annual attachment points (the amount at which the insurance begins to pay claims), including a minimum individual claim threshold of $20,000 and an aggregate claim threshold that is either 120% of expected claims or $20,000, with these amounts to be indexed annually using the Consumer Price Index for Medical Services. The bill also preserves language allowing insurers to provide additional incentives for small employers that focus on health care outcomes, medical home models, and preventive screenings. The changes will become effective on October 1, 2025, and will apply to insurance contracts issued, renewed, or amended on or after that date, giving insurers and small employers time to adapt to the new regulations.

https://www.ncleg.gov/BillLookUp/2025/S218