Medical Stop Loss

Summary of Coverage

Medical stop loss insurance protects employers with self-funded health plans against the risk of severe losses.

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 is $1,000,000; options of $2,000,000, $5,000,000, $10,000,000*
• Full range of contract claims basis: 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:

Our 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 Basis: 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

Additional advantages:

• Extensive technical and medical staff resources onsite
• Claim repricing capabilities with access to several passive PPO repricing arrangements
• Utilization review and case management oversight programs
• Direct access to decision making personnel in administration, claims and underwriting