concluding “that under Texas law stop-loss insurance is not accident and sickness insurance”
How later courts described this case
- concluding “that under Texas law stop-loss insurance is not accident and sickness insurance”
- state law does not regulate employer’s self-insured plan with stop-loss coverage; distinguishes between stop-loss insurance and primary coverage on basis that stop-loss only covers plan itself and plan is still liable to employees; does not reach ERISA preemption issue
- distinguishing insurance policies that protect sick or injured employees from policies “protecting employee benefit plans from catastrophic loss.”
Written by the judges who cited it.
The opinion
REAVLEY, Circuit Judge,
concurring:
I agree with both of my colleagues that Tuneup Masters Employee Benefit Plan “does not incur any losses because of newborns with congenital defects, and the state is preempted by ERISA from requiring the Plan to include those losses.” Having decided that matter, the NALAC policy, which only reimburses the Plan for claims paid in excess of $30,000, presents us with no legal questions and the Browns with no benefits. NALAC insures no one for any claim until the Plan has paid a claim in excess of $30,000. The Texas statute does not rewrite the contract between the Plan and NALAC to provide first dollar coverage, for newborns only, and neither should this court.
I concur in the affirmance.