In the continuing wake of PPACA, Spectrum recognizes that small employers now more than ever need viable financing options for their employee medical benefit plans.  With that in mind, Spectrum offers traditional Specific & Aggregate Stop Loss Insurance and Integrated Stop Loss Insurance for groups as small as 15 covered employee lives.

For traditional Specific & Aggregate Stop Loss Insurance, the 15-life minimum is available in 44 states and the District of Columbia.  The applicable minimum case size by state is as follows:

  • 15 Covered Employee Lives:  Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin & Wyoming.
  • 26 Covered Employee Lives:  North Carolina
  • 51 Covered Employee Lives:  California, Florida, Minnesota, New York & Utah.

For Integrated Stop Loss Insurance, the 15-life minimum is also available in 43 states and the District of Columbia.  The applicable minimum case size by state is as follows:

  • 15 Covered Employee Lives:  Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin & Wyoming.
  • 25 Covered Employee Lives:  Delaware
  • 26 Covered Employee Lives:  North Carolina
  • 51 Covered Employee Lives:  California, Florida, Minnesota & Utah
  • Not Available:  New York

As always, please contact us with any questions or comments by calling 800-804-7732 or email us by clicking here.

Integrated Stop Loss Highlights *UPDATED*

Published on June 05, 2015

You Asked – We Answered!

For many years, TPAs have been asking the stop loss community for help in writing new self-funded business away from the dreaded fully-insured carriers (BUCAs).  Spectrum Underwriting Managers has the solution – Integrated Stop Loss Insurance – the ultimate production tool for TPAs looking to write new business away from the fully-insured market.

Integrated Stop Loss Insurance is the ultimate bridge product for small employers seeking a simple way to move from a fully-insured group health plan to a true self-funded medical benefits plan.  Like traditional stop loss insurance, Integrated Stop Loss Insurance is a catastrophic cover for a self-funded medical benefits plan.  The employer will enjoy all the benefits of traditional self-funding while enjoying the ease, look and feel of a fully-insured group health plan.

With Integrated Stop Loss Insurance there is only one maximum retention to satisfy before excess claims are reimbursed.  This maximum retention is spread over 12 equal monthly payments that do not fluctuate with claim activity.  There is no specific retention, nor is there an internal maximum limit on individual claims that apply toward the Integrated Stop Loss Insurance retention.  This retention could be satisfied by just one catastrophic claim.

Integrated Stop Loss Insurance (ISL) Highlights…

  • Designed for employers with 15 to 199 employees currently covered under a fully-insured group health plan (state-specific minimums may apply)
  • Bridge product providing a simple way to convert from a fully-insured group health plan to a true self-funded group health plan
  • All the benefits of traditional self-funding with the ease, look and feel of a fully-insured group health plan
  • True ERISA plan
  • Complete flexibility with benefit plan design
  • Not subject to state-mandated benefits
  • Lower maximum plan costs than our traditional stop loss insurance each and every time
  • More competitive against fully-insured quotes
  • Bridge product to traditional specific & aggregate stop loss insurance
  • Employer writes just one check each month (based on plan enrollment)
  • Monthly payment covers both ISL premium and ISL retention funding (TPA handles the split between premium and claim funding account)
  • TPA manages the claim funding account, just like traditional stop loss
  • ISL retention is spread over 12 monthly payments that do not fluctuate with claim activity; only with plan enrollment
  • Unlike traditional stop loss insurance, just one retention to satisfy before excess claims are reimbursed
  • ISL retention accumulates monthly – excess claims are reimbursed based on the accumulated attachment point
  • Never an additional claim funding request (provided the ISL retention is fully funded, of course)
  • No specific retention to satisfy
  • No internal maximum limit (beyond requested annual or lifetime limits) on individual claims that apply toward the ISL retention
  • ISL retention could be satisfied by just one catastrophic claim
  • Employer retains all unused ISL retention funding at year-end
  • Unlimited lifetime maximums available
  • First-year 12/12, 12/15 and 12/18 contracts are available
  • 12/12 contracts renew on a 24/12 basis
  • Terminal liability available (for a 10% premium load and a 3-month extension of aggregate funding factors based on average plan enrollment in months 10 thru 12)
  • 4-day guaranteed claim turn-around time on excess claims
  • Fewer & easier reporting requirements for the TPA
  • Pay-then-audit claim procedure
  • Quarterly reconciliation on claim fund surplus over $1,000
  • Standard disclosure statement required within 60 days of the effective date
  • Available in 49 states and the District of Columbia (certain state-specific restrictions apply)
  • Not available in New York
  • Maximum 5% producer commission available on ISL premium

Plan Participant Disclosure Statements

Published on October 08, 2012

Beginning with January-2013 effective dates, Spectrum will require completion of Plan Participant Disclosure Statements on new-business sold cases where individual participant claims experience is unavailable.

This additional disclosure information is required only when individual participant claims experience is unavailable (e.g., small fully-insured employers) and is intended to supplement the Plan Sponsor Disclosure Statement that is also required on all newly-sold cases.  Information obtained from these statements is vital to the final sold-case underwriting process on groups without individual participant claims experience, and can also be a valuable tool to the employer when evaluating self-funding as a benefit financing option.

Requirement Parameters

  • Plan Participant Disclosure Statements are required on all new-business sold cases where individual participant claims experience is unavailable.
  • Plan Participant Disclosure Statements must be completed, signed and dated by all employees no sooner than three (3) months prior to the proposed effective date of the stop loss coverage.
  • If other, similar forms (i.e., from another carrier) have already been completed by all employees, Spectrum will accept those forms provided they are current to within three (3) months of the proposed effective date of the stop loss coverage.
  • Plan Participant Disclosure Statements may be submitted at any time during the underwriting process, but are not required until the final sold-case underwriting process as a supplement to the Plan Sponsor Disclosure Statement.  From a timing standpoint, Spectrum strongly recommends that these participant forms be submitted in conjunction with the Plan Sponsor Disclosure Statement.
  • If submitted at any time after the initial quote is released, stop loss terms may be revised.

The Plan Participant Disclosure Statement will be used to accurately assess the risk characteristics of the employer group.  The form is just one page and is divided into several sections, as follows:

  • General Employee Information
  • Covered Dependent Information
  • Medical Information (for the employee and its dependents)
    • Details required include:
      • Name of person referenced.
      • Medical condition.
      • Current and past treatment including medications and/or prescriptions.
      • Date range to include date of diagnosis and date of last treatment and/or medication/prescription.
      • Prognosis and status of the condition and if the condition ongoing.
  • Declaration of Completeness and Accuracy with Signature and Date

If you would like a PDF copy of the Plan Participant Disclosure Statement and instructions for completion, please contact us by calling 800-804-7732 or email us by clicking here. Thank you.