Self-funding is an effective financial tool employers use to manage employee benefit plan costs. It allows flexibility in plan design and lower overall expenses, as well as tax and legal advantages typically not found in fully-insured employee benefit plans.

Employers purchase Medical Stop Loss Insurance for financial protection against individual catastrophic claims and/or a high frequency of smaller claims. The type and level of Medical Stop Loss Insurance purchased should reflect the employer’s size, cash flow and risk tolerance.

Spectrum offers a variety of Medical Stop Loss Insurance products for single employer groups with as few as 15 employee lives. These products are available through an impressive nationwide network of Third Party Administrators, Brokers and Benefits Advisors.

Specific Stop Loss – Protection against the financial risk of a catastrophic claim in excess of an individual specific retention applicable to each plan participant.

  • Minimum Specific Retention:  $10,000
  • Lifetime Maximum:  Unlimited
  • Contract Basis:  12/12, 12/15, 12/18, 12/24, 15/12, 24/12 & Paid
  • Coverage:  Medical (standard); Rx (optional)
  • Specific Advance Reimbursement:  Standard
  • Aggregated Specific Retention:  Optional
  • Specific Terminal Liability:  Optional
  • “No New Laser / Renewal Rate Cap”:  Optional

Aggregate Stop Loss – Protection against the financial risk of a large accumulation of claims that fall below the specific retention and are in excess of an annual aggregate retention on the plan as a whole.

  • Standard Attachment Point:  125% of expected claims
  • Aggregate Limit:  $1,000,000 ($2,000,000 available)
  • Contract Basis:  12/12, 12/15, 12/18, 12/24, 15/12, 24/12 & Paid
  • Coverage:  Medical (standard); Rx, Dental, Vision and WDI (optional)
  • Monthly Aggregate Accommodation:  Standard <100 lives; Optional 100+ lives
  • Aggregate Terminal Liability:  Optional

Integrated Stop Loss – Level-funded protection against the financial risk of claims in excess of an accumulating monthly integrated aggregate retention applicable to the plan as a whole.

  • Integrated Aggregate Limit:  Unlimited
  • Claim Limit Per Participant:  Unlimited (lower limits available)
  • Contract Basis:  12/12, 12/15, 12/18, 12/24, 15/12, 24/12 & Paid
  • Coverage:  Medical (standard); Rx, Dental, Vision and WDI (optional)
  • Integrated Terminal Liability:  Optional

If you are a TPA, Broker or Benefits Advisor in need of a quality stop loss resource for your self-funded clients…
Call us today at 317.692.3285