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