UPDATES: COURT STRIKES STOP-LOSS RULE

RICHMOND, Va.-In a victory for employers that self-insure their health care benefit plans, a federal appeals court says a Maryland insurance regulation defining when stop-loss insurance policies are considered health insurance and subject to state benefit mandates is pre-empted by federal law.

A three-judge panel of the 4th U.S. Circuit Court of Appeals earlier this month affirmed a 1996 lower court ruling that the Maryland regulation is pre-empted by the Employee Retirement Income Security Act. ERISA pre-empts state laws that "relate" to employee benefit plans. The 4th Circuit ruling is the first time a federal appeals court has ruled on the issue.

At issue is a Maryland regulation that says stop-loss insurance policies must have at least a $10,000 attachment point for specific claims and an aggregate attachment point of 115%of expected claims. Policies below those levels are considered health insurance and must abide by state requirements.

Opponents of the Maryland requirement, including the Self-Insurance Institute of America, say that ERISA denies states such authority. They also note that such requirements would subject employers to state health insurance mandates that raise the cost of providing benefits.

The issue also has been litigated in Missouri, where the state insurance commissioner has been blocked by state courts from implementing a stop-loss regulation similar to Maryland's.

However, the Maryland Insurance Department plans to ask that all 13 judges rehear the case, according to Thomas P. Raimondi, associate deputy commissioner.