Minimum Surplus; Capital Requirements; Security Deposit; Annual Audit; Aggregate Excess Stop-Loss Coverage; Individual Excess Stop-Loss Coverage

  1. Law
  2. Georgia Code
  3. Insurance
  4. Multiple Employer Self-Insured Health Plans
  5. Minimum Surplus; Capital Requirements; Security Deposit; Annual Audit; Aggregate Excess Stop-Loss Coverage; Individual Excess Stop-Loss Coverage

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  1. No multiple employer self-insured health plan shall be licensed unless it shall possess and thereafter maintain a minimum surplus of at least $200,000.00.
  2. A multiple employer self-insured health plan shall be subject to and comply with the applicable regulatory action level risk-based capital requirements prescribed by Chapter 56 of this title.
  3. Every multiple employer self-insured health plan shall maintain a security deposit with the Commissioner. The amount of the deposit shall be $100,000.00 and shall be in the form of securities eligible for the investment of capital funds of domestic insurers. The deposit shall be administered in accordance with the provisions of Chapter 12 of this title.
  4. Every multiple employer self-insured health plan shall annually obtain an opinion from a qualified actuary as to the adequacy of its loss reserves. Such opinion shall be prepared and issued based on standards adopted from time to time by the Actuarial Standards Board and in accordance with instruction prescribed by the National Association of Insurance Commissioners.
  5. Every multiple employer self-insured health plan licensed pursuant to this chapter shall have an annual audit by an independent certified public accountant in accordance with Georgia Department of Insurance Regulation 120-2-60 and instructions prescribed by the National Association of Insurance Commissioners.
  6. Every multiple employer self-insured health plan shall file financial statements with the Commissioner in accordance with the provisions of Georgia Department of Insurance Regulation 120-2-18-.06.
    1. Every multiple employer self-insured health plan shall obtain and thereafter maintain aggregate excess stop-loss coverage and individual excess stop-loss coverage.
    2. Excess stop-loss coverage required by this Code section shall be issued by an insurer licensed by the state.
    3. The retention limits for both the aggregate excess stop-loss coverage and individual excess stop-loss coverage shall be determined annually by a qualified actuary based on sound actuarial principles.
    4. Any stop-loss contract maintained pursuant to this Code section shall contain a provision that the stop-loss insurer shall give the multiple employer self-insured health plan and the Commissioner a minimum of 180 days' notice of cancellation or nonrenewal.
    5. If the multiple employer self-insured health plan fails to obtain replacement coverage within 90 days after receipt of the notice of cancellation or nonrenewal, the trustees of the plan shall provide for the orderly liquidation of the multiple employer self-insured health plan.
    1. Each participating employer shall be jointly and severally liable for all legal obligations of the multiple employer self-insured health plans created on or after July 1, 2010.
    2. If the assets of the multiple employer self-insured health plan are at any time insufficient to enable the plan to discharge its legal liabilities and other obligations and to maintain the surplus required under this Code section, it shall forthwith make up the deficiency or levy an assessment upon its participating employers for the amount needed to make up the deficiency.
    3. If the multiple employer self-insured health plan fails to make up the deficiency or make the required assessment within 30 days after the Commissioner orders it to do so or if the deficiency is not fully made up within 60 days after the date on which any such assessment is made or within such longer period as may be specified by the Commissioner, the plan shall be deemed to be insolvent.
    4. If the liquidation of a multiple employer self-insured health plan is ordered, an assessment shall be levied upon its participating employers for such an amount as the Commissioner determines to be necessary to discharge all liabilities of the plan, including the reasonable costs of liquidation.

(Code 1981, §33-50-5, enacted by Ga. L. 1991, p. 1021, § 1; Ga. L. 2010, p. 757, § 3/SB 310; Ga. L. 2011, p. 752, § 33/HB 142; Ga. L. 2019, p. 533, § 1-12/HB 99; Ga. L. 2020, p. 493, § 33/SB 429.)

The 2019 amendment, effective July 1, 2019, substituted "Georgia Department of Insurance" for "Georgia Insurance Department" in subsections (e) and (f); and substituted "Reserved" for the former provisions of subsection (i), which read: "A multiple employer self-insured health plan licensed before January 1, 2010, shall have until December 31, 2011, to comply with the provisions of this Code section."

The 2020 amendment, effective July 29, 2020, part of an Act to revise, modernize, and correct the Code, deleted former subsection (i) which was designated as reserved.


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