Health Insurance Coverage: Stop-Loss
Employer Stop-Loss coverage protects employers with self-funded health plans from unexpected or catastrophic health claims, thus limiting risk while maintaining the advantages of self-funding. In recent years, there has been a significant increase in both the frequency and severity of large medical claims due to multiple factors. In the past many large employers have elected not to purchase stop-loss coverage. Often this decision was driven by the knowledge that annual and lifetime maximums would protect them in the event of a true medical catastrophe. With Health Care Reform eliminating all annual and lifetime limits, employers that have used this plan design component as an internal pooling mechanism are now faced with a new reality. We firmly believe that even the largest employers should purchase some high level of stop-loss insurance to protect themselves against potential catastrophic losses.
There are an abundance of insurance carriers who participate in the employer stop-loss market and as a result, it has become highly commoditized. The professionals at Dubraski & Associates are experts in navigating these options. As the largest, most experienced broker/consultant in the managed care stop-loss business, we are able to leverage our relationships with these specialty markets that are primarily unknown to traditional brokers to develop unique and modern solutions for self-insured medical programs.
Stop-Loss Insurance Proposal Process
We begin our unique process by performing a series of detailed financial analytics using our client’s own historical data. We then obtain terms from the traditional employer stop-loss carriers, the managed care carriers and any other source that may be available to our clients. Next, we evaluate all options against our analytics and negotiate aggressively on our client’s behalf, making adjustments when appropriate for industry trends. Whenever possible, we leverage our client’s purchasing power by consolidating all “at risk” lives under one program. We are also able to leverage our position as the largest managed care stop-loss broker to ensure the best outcome for our clients. The results of this process, when considered alongside our client’s risk appetite and financial strength, determine the final structure for the stop-loss program.
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