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Medical Stop Loss

Medical Stop Loss is a layer of coverage that provides insurance protection to employers who choose to self-fund their health benefit plans. Self-funding is an effective approach employers use to significantly reduce health benefit costs and maintain control over reserves without sacrificing coverage. In addition to avoiding the excessive overhead costs frequently associated with fully-insured plans, employers also receive some tax benefits from self-funding. However, self-funding can incur risks from large catastrophic claims. Medical Stop Loss insurance from Tokio Marine HCC - Stop Loss Group is designed to protect employers from that risk.

Our Underwriting, Claims, Policy Administration, Marketing & Sales, Premium Accounting and Licensing departments stand ready to help you process your clients’ stop loss insurance needs.

New to self-funding? Please check our Glossary or Medical Stop Loss FAQ for common terminology and quick answers to common questions about medical stop loss.

Product Highlights

  • Minimum size group of 50 lives or more
  • Discounts for quality PPOs, UR, Large Case Management programs and quality plan documents
  • Flexible medical stop loss contract
  • Turnkey captive option available through HCC Risk Solutions Company (HCC RSC)

Specific Stop Loss Summary of Coverage

Our Specific Stop Loss Coverage provides a protection against catastrophic claim above the specific deductibles. Specific deductibles available from $10,000 to $1,000,000*.
  • Standard maximum limit: $1,000,000; options of $2,000,000, $5,000,000, $10,000,000*
  • Full range of contract claims bases: 12/12, 12/15, 12/18, 12/24, 12/36, 14/12, 15/12, 18/12, 24/12, Paid, Incurred.

Aggregate Stop Loss Summary of Coverage

Tokio Marine HCC - Stop Loss Group's Aggregate Stop Loss coverage provides protection in the event the total paid losses exceed the expected claims plus corridor during the policy period. Flexible attachment points; 125% standard. Lower/higher available*.
  • Claims Bases: 12/12, 12/15, 12/18, 15/12, 24/12, PAID
  • Standard Maximum limit: $1,000,000; options of $2,000,000, $5,000,000, $10,000,000*
  • Monthly or annual aggregate premium payment available

Optional Features

  • Specific split-funded premium arrangement
  • Simultaneous funding on specific reimbursements
  • Monthly aggregate advance reimbursement
  • Terminal aggregate liability coverage
  • Terminal specific liability benefit
  • Medical conversion available
  • Contract Advantage Plan (CAP)
  • Early Lock Down
  • Split-Funded Aggregate

Value-Added Services

In addition to our innovative Medical Stop Loss insurance, Tokio Marine HCC - Stop Loss Group offers the following value-added services:
  • Extensive technical and medical staff resources on-site
  • Claim re-pricing capabilities; access to several passive PPO re-pricing arrangements
  • Utilization Review and Case Management oversight programs
  • Direct access to decision making personnel in administration, claims and underwriting

Contacts

For more complete information, please contact a medical stop loss regional representative.

Medical Stop Loss forms are available in the Resources section.

*Policies vary by state or may contain certain exclusions and limitations.

 

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