Flexibility in both product design and underwriting practices allows ABC to develop Stop-Loss programs that achieve the desired balance between risk assumption and cost. ABC acts as General Agents for Elite Underwriting, the nations #1 MGU for Stop Loss. Elite's underwriters have an average of 15 years experience in Stop Loss, giving them an unparelled advantage on the true understanding of risk. This experience enables ABC and Elite to underwrite almost any industry and have the product flexibility required to insure groups with as few as 150 or as many as 100,000 lives. Elite prides itself on partnering with its producers like Applied Benefit Concepts in order to create the program structure necessary to meet your clients' unique needs.
More About Stop-Loss
Under a self funded medical plan, an employer chooses to pay employee medical claims directly out of company funds, through a trust or TPA. The employer plan is subject to catastrophic losses, on both an individual and aggregate claim basis. In designing the medical plan, the employer reviews how to protect the plan against catastrophic claim losses. Stop Loss Insurance is the coverage the employer purchases to protect the plan from such losses and transfer the risk to an insurance carrier.
ABC offers two types of Stop-Loss protection: Individual Stop-Loss & Aggregate Coverage
Individual Stop Loss protects the employer’s exposure from high expenses for each individual covered under the plan in excess of the specific deductible. Under the provision of the stop loss policy, the employer is reimbursed for eligible medical expenses. The stop loss carrier reimburses the employer for amounts over the deductible, which is established by the employer. The specific deductible is determined by the employer and its tolerance for risk.
Aggregate Coverage is provided to the employer to limit the overall claim exposure of the plan. With this coverage, the accumulation of expenses for all individuals is calculated and tracked. Claims reimbursed under the specific coverage, are not accumulated under the aggregate coverage for any amount that exceeds the specific retention. Under the aggregate coverage claims are reimbursed at the end of the contract period, unless monthly aggregate is purchased as a contract option.
In summary, stop loss is only one component of a self funded plan analysis. It provides the financial assurance for protecting the employer’s plan.