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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.
SLG Benefits and Insurance, LLC is a medical stop loss insurance
Program Manager established to provide expertise and timely solutions
to the medical stop loss and claim administration community. The
company was created to surpass the needs of Third Party Administrators
(TPA's) and broker/consultants specializing in the self-funded
employee benefits market. |
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
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Specific Stop Loss 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
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Aggregate Stop Loss
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
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Risk Management Rating Credits (more details)
SLG
Benefits and Insurance, LLC has developed a stop loss pricing model to
recognize and reward Business Partners who actively report Claimant
information based on the
criteria described. We cannot stress enough the importance of
early notification based on the proven cost management techniques
employed by many top firms today. Cost controls have become even more
important in recent years as employers have elected to take on more
risk to stem inflationary pressures on stop loss rates. SLG Benefits
established their Risk Management Department to facilitate the
delivery of innovative cost containment techniques to produce real
savings to the client both above and below the specific deductible
selected. We believe these efforts will ultimately result in
longer-term stability in the employer’s stop loss pricing.
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Optional Coverage
- Specific Advance Reimbursement
- Split Funded or Aggregating
Specific Options
- Specific Terminal Liability Option
- Aggregate Accommodation Option
- Aggregate Terminal Liability
Option
- Medical Conversion Option
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Value Added Services
- Consultative underwriting and
marketing services
- Internal claims re-pricing
services
- Risk Management Oversight programs
- On-site technical and clinical
expertise
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