Provided by Stop Loss Group

Level Funded

Level Funded Stop Loss provides a unique pathway for fully insured clients to migrate to self-funding. It establishes a fixed monthly budget for claims coverage within the employers self-funded health plan, transparency into health care spend, increased benefit flexibility, no lasers, and 100% recoupment of unused claims funds. In an effort to meet our clients’ unique benefit needs, this stop loss product provides a combination of predictability, savings, flexibility and control.

How does Level Funded Stop Loss Work? 

  • Employers pay a monthly stop loss premium and a PEPM amount equal to its Monthly Aggregate Deductible to cover claims
  • If the total actual claims costs exceed the accumulation of the employer's Monthly Aggregate Deductible paid at any time during the policy period, the stop loss policy reimburses the balance
  • Any remaining Monthly Aggregate Deductible amounts at the end of the contract are retained by the employer

Benefits of Level Funded Stop Loss:

  • Provides predictable monthly cash flow
  • Financially rewarded for low claims costs and retain all unused funds
  • Flexibility in plan design, contract type and network
  • Control and transparency in employers’ health plans

Our Differences

Low Max Cost
  • Level Funded Stop Loss combines underwriting methodologies of both fully insured and self-funding, creating a lower maximum obligation for the client.
  • No Lasers.
  • Our Level Funded Stop Loss is an aggregate only product, does not contain lasers or split funded liabilities. We are committed to offering all clients a non-laser renewal, while still providing an unlimited maximum per person.
  • Producers and Third-Party Administrator (TPA) partners have the flexibility to be creative in the schedule of benefits.
  • Ability to incorporate market leading point solutions and Pharmacy Benefit Managers.
  • Ability to incorporate payment arrangements using Reference Based Pricing and/or traditional PPO networks.
  • Transparency and Control.
  • Clients know their exact claims cost.
  • Claims are reimbursed daily resulting in no cash calls. All unused Monthly Aggregate Deductibles are retained by the client regardless if they renew or terminate.
Flexible Contracts
  • Clients can elect contracts that include run-out, such as 12/18 or 12/24. They can also elect to minimize first year expenses by electing a 12/12, which allows them to renew with run-in protection.
  • TLO is an optional provision for contracts without run-out protection.
Underwriting Guidelines

Case Size

  • 25 employees required to quote, varies to comply with state laws and regs.

Participation Requirements

  • 75% participation of all eligible employees is required.

Ineligible Industries.

  • PEOs, MEWAs, Associations
  • Long haul trucking
  • Employee leasing firms
  • Tribal owned firms
  • Bars and Casinos

Quote Requests Must Include:

  • Member census of all employees
  • Current Schedule of Benefits
  • Current rates and, if available, renewal rates
  • All available claims experience.

Related products

why choose tmhcc

Why choose Tokio Marine HCC?

Tokio Marine HCC is a leading specialty insurance group with offices in the United States, Mexico, the United Kingdom and Europe, transacting business in approximately 180 countries and underwriting more than 100 classes of specialty insurance.

More about us Financial strength

Not all products, coverages, or features may be available in all states. Restrictions, exclusions, limitations, and conditions apply and you should see your agent for more information. Certain products and services are provided through non-admitted insurance carriers and are not subject to certain State Guaranty Funds.

HCC Life Insurance Company operating as Tokio Marine HCC - Stop Loss Group