3234*2 - Limitations on administrative services and stop-loss coverage.

* §   3234.  Limitations  on  administrative  services  and  stop-loss  coverage.  No insurer, subsidiary of an insurer, or controlled person of  a holding company system may act as an administrator  or  claims  paying  agent,  as  opposed  to an insurer, on behalf of a group which denies or  limits benefits for a specific disease or condition or for  a  procedure  or treatment unique to a specific disease or condition in a manner which  would  be  inconsistent  with this chapter or regulations promulgated by  the superintendent  had  the  group  purchased  insurance.  No  insurer,  subsidiary  of an insurer, or controlled person of a holding company may  provide stop loss, catastrophic or reinsurance coverage to groups  which  deny  or  limit  benefits  for  a specific disease or condition or for a  procedure or treatment unique to a specific disease or  condition  in  a  manner  which  would  be  inconsistent  with this chapter or regulations  promulgated by the superintendent had the group purchased  insurance.  A  limit,  maximum, or other mechanism that controls total coverage without  regard to a specific disease or condition shall not be deemed  one  that  denies  or limits benefits for a specific disease or condition, or for a  procedure or treatment  unique  to  a  specific  disease  or  condition.  Nothing  herein shall be construed to mandate the inclusion of specified  benefits in an employer group plan, if such plan is not subject  to  the  provisions of this chapter.    * NB There are 3 § 3234's