Medical Stop Loss

Medical stop loss provides an added layer of insurance protection to employers who choose to self-fund their health benefit plans. Self-funding can incur risks from catastrophic claims. Medical stop loss insurance from Tokio Marine HCC is designed to protect employers from that risk. Our underwriting, claims, policy administration, marketing and sales, premium accounting and licensing departments stand ready to help you manage your clients’ stop loss insurance needs.

Highlights

Product highlights:

  • Minimum group size 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

Best For

  • Employers with self-funded health plans

Summary of Coverage

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
  • Split-funded aggregate

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


Related Products

Why Tokio Marine HCC?

Tokio Marine HCC is a leading specialty insurance group with offices in the United States, the United Kingdom, Spain and Ireland, transacting business in approximately 180 countries and underwriting more than 100 classes of specialty insurance. Our products and capabilities set the standard for the industry, and many of our almost 3,000 employees are industry-leading experts. Each of our highly entrepreneurial businesses are equipped to underwrite special situations, companies and individuals, and acts autonomously to deliver effective solutions. 

Our financial strength ensures our clients will always be protected.

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Our holistic portfolio of products includes more than 100 classes of specialty insurance

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Tokio Marine HCC is part of Tokio Marine, a $31 billion company

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