NOTICE - USBenefits Insurance Services, LLC is not a Claims Administrator nor do we solicit business from individual consumers, and we are not affiliated with US Benefits / UMTA Trust (Oregon).

USBenefits can assist you and fully insured clients to consider if stop loss is appropriate for their needs. To help us properly and expeditiously review your RFP, all fully insured submissions are subject to the following in addition to our underwriting guidelines.

  • Minimum lives – 51 lives.
  • Detailed claim information is preferred, but we will consider health questionnaires.
  • We will consider run out – 12/12, 12/15 or 12/18 terms.
  • Our minimum corridor is 125%

Perhaps the greatest reason why an employer wants to consider stop loss is the ability to reduce their healthcare spend, especially in light of rising medical costs and challenging economic times. At USBenefits, we believe there are other advantages to stop loss.

  • It allows the employer to have more flexibility in the benefits they choose for their employees which can improve employee retention and satisfaction.
  • The plan keeps the profit margin between the cost of fully insured and administrative cost of self funding. Over many years, this can result in a substantial increase in a company’s bottom line.
  • The plan can purchase stop-loss insurance to protect the plan from catastrophic claim costs, which will give the plan a more stable benefit cost structure.
  • Self funding gives the plan more control over its healthcare expenditures.

If you are looking to buy a “one size fits all” standardized health insurance coverage, then fully insured/first dollar coverage might be your choice. However, if you want long-term stability, the ability to control the costs of your insurance product and wish to evaluate your coverage to ensure a return on investment, then self-insuring might be the financial vehicle you’ve been looking for.

If the incumbent fully insured carrier withholds on providing detailed claims data, don’t give up. It’s often available, especially for groups whose lives are greater than 150.

We welcome the opportunity to discuss and serve your needs.

About USBenefits
USBenefits Insurance Services, LLC dba Employer Stop Loss Insurance Services, LLC (USB) is a full-service Managing General Underwriter. Please contact a USBenefits team member or Chris Phalen at 949-468-3028 for more information.