Integrated Stop Loss Insurance is the ultimate bridge product for employers seeking a simple way to move from a fully-insured group health plan to a true self-funded group health plan. Like traditional specific & aggregate stop loss insurance, Integrated Stop Loss is catastrophic coverage for self-funded group health plans. Employers enjoy all the benefits of traditional stop loss while also enjoying the ease of operation of a fully-insured group health plan. Best of all, Integrated Stop Loss always has a maximum cost lower than Spectrum’s traditional specific & aggregate coverage.
With Integrated Stop Loss there is just one maximum retention to satisfy before excess claims are reimbursed. The maximum retention is spread over 12 equal monthly payments that do not fluctuate with claim activity, only with enrollment. There is no specific retention to satisfy, nor is there an internal maximum limit on individual claims that apply toward the Integrated Stop Loss retention. The retention could be satisfied by just one catastrophic claim.
Highlights of Integrated Stop Loss:
- Designed for employers as small as 15 employee lives (state-specific minimums apply)
- 4-day guaranteed claim turn-around time on excess claims
- All the benefits of traditional self-funding with the ease of a fully-insured group health plan
- Employer retains all unused ISL retention funding at year-end; Spectrum NEVER touches the employer’s claims fund
- A true ERISA plan allowing for complete flexibility with benefit plan design
- Lower maximum plan costs than traditional stop loss insurance
- More competitive against fully-insured competition
- Employer writes just one check each month that covers both ISL premium and ISL retention funding (the TPA handles the split between premium and the claims account)
- TPA manages the claim funding account, not Spectrum
- ISL retention is spread over 12 monthly payments that do not fluctuate with claim activity; only with plan enrollment
- ISL retention accumulates monthly – excess claims are reimbursed based on the monthly-accumulating ISL retention
- Never an additional claim funding request (provided the ISL retention is fully funded)
- First-year 12/12, 12/15 and 12/18 contracts are available
- Terminal liability available
- Pay-then-audit claim procedure
- Quarterly reconciliation on claim fund surplus over $1,000
Contact Spectrum’s Sales Team for more information. Please see the staff page for contact information.