Sec. 101.6. Provider stop loss insurance

(a) No stop loss insurer may issue or deliver in this State a policy of provider stop loss insurance unless the insurer is authorized to issue a provider stop loss insurance policy in this State; pursuant to the provisions of section 4237-a of the Insurance Law.

(b) No policy of provider stop loss insurance shall permit the stop loss insurer to rescind the policy and no insurer shall rescind such policy.

(c) No policy of provider stop loss insurance may be issued or delivered in this State unless the policy, in substance provides:

(1) that the termination of the policy shall not affect or reduce the stop loss insurer's obligation to, or responsibility for, coverage to health care providers for covered claims which occurred during the term of the policy;

(2) that in the event of the termination of the financial risk transfer agreement by the superintendent, pursuant to the provisions of section 101.9(a)(7) of this Part, the insurer is the designated beneficiary for subscribers covered by the stop loss insurance coverage for incurred but unpaid benefits for the time frame for which in-network capitation payments were received by the health care provider; and

(3) that the stop loss insurer will provide notice (whether initiated by insured or the stop loss insurer) of termination, cancellation, nonrenewal, or material change to the terms of the coverage, to the health care provider and insurer at least 90 days prior (or 45 days notice of cancellation for nonpayment of premium) to the effective date of the notice.