Texas Supreme Court Holds Sale of Stop-Loss Insurance is Subject to State Insurance Code Regulation

June 15, 2012
In a recent decision, the Texas Supreme Court held that an insurer?ÇÖs sale of stop-loss insurance to a self-funded group health plan is subject to taxes and other regulatory requirements under the Texas State Insurance Code (?Ç£Code?Ç¥). The court of appeals previously held that the employer?ÇÖs self-funded group health plan was an insurer under the Code and thus the plan?ÇÖs purchase of stop-loss insurance was reinsurance that was beyond the regulatory scope of the Texas Department of Insurance. The insurer argued that stop-loss insurance fell within the Code?ÇÖs exception for reinsurance, but the Supreme Court reversed the decision of the court of appeals and found that stop-loss insurance sold to the self-funded employee health plan is not reinsurance, but rather direct insurance subject to regulation under the Code. Texas Dept. of Insurance v. American National Insurance Co., No. 10-0374 (Tex. May 18, 2012).
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