PRODUCT OVERVIEW

Self-funding is an effective approach that employers can use to gain greater flexibility and control over their health plan costs. In order to provide an extra measure of financial protection against catastrophic claims, most self-funded employers purchase Medical Stop Loss coverage. The amount of risk to be reinsured is a function of the employer's size, nature of business and risk tolerance. Employers can take advantage of several benefits not necessarily available under a traditional fully insured program such as lower operating costs, increased cash flow, flexibility in plan design and better claim management. In addition, self funded employers often enjoy reduced premium taxes since most states tax only the stop loss premiums and not the self-funded claim fund.

PRODUCT HIGHLIGHTS

• Minimum group size of 35 lives

• PPO, UR and Large Case Management program credits

• Consultative pricing including “no laser” renewal guarantee

• Market competitive Excess Loss Contract

SPECIFIC COVERAGE *  top of page

Specific Coverage is provided to limit the employer’s cost for eligible medical expenses for each covered individual. This coverage addresses the employer’s exposure to high expenses on a given individual (as opposed to an accumulation of expenses on all individuals).

• Specific Deductibles from $15,000 to $500,000

• Lifetime Maximums available: $1,000,000, $2,000,000 & $5,000,000

• Contract Basis: 12/12, 12/15, 12/18, 12/24, 14/12, 15/12, 18/12, 24/12 and PAID

• Coverage options available: Medical, RX

AGGREGATE COVERAGE *  top of page

Aggregate Coverage is provided to limit the employer’s overall annual cost for a self-funded plan. This coverage addresses the accumulation of expenses on all individuals (as opposed to high expenses for particular individuals).

• Flexible Attachment Points with 125% standard

• Per Policy Period Maximum available: $1,000,000

• Contract Basis: 12/12, 12/15, 12/18, 14/12, 15/12, 18/12, 24/12 and PAID

• Coverage options available: Medical, RX, Dental, Vision and WDI

*Variations and alternatives are available to tailor the product to each individual client’s needs. Please contact your underwriter for details.

OPTIONAL COVERAGE  top of page

• Specific Advance Reimbursement

• Split-Funded or Aggregating Specific Options

• Specific Terminal Liability Option

• Aggregate Accommodation Option

• Aggregate Terminal Liability Option

• Medical Conversion Option

VALUE-ADDED SERVICES  top of page

• Consultative underwriting and marketing services

• Internal claims re-pricing services

• Risk Management Oversight programs

• On-site technical and clinical expertise