Self-Funding and Stop Loss Insurance

Self-funding is an alternative funding method for an employer to provide health benefits to employees and their dependents. Unlike traditional health insurance, a self-funded employer has the responsibility for payment of claims under the health plan.

How Does Self-Funding work?

A self-funded employer hires a plan administrator for:

  • Benefit plan design and administration
  • Access to managed care networks (e.g. PPOs, Case Management, PBMs)
  • Claim adjudication

Where does Stop Loss Insurance fit in?

The self-funded employer purchases Stop Loss insurance (also known as Excess Loss insurance) for protection against very large claims under the health care plan. Specific and/or aggregate Stop-Loss insurance may be purchased on an annual basis.

Under a self-funded arrangement, the employer group/plan sponsor:

  • has the advantage of increased plan design flexibility and enhanced reporting capabilities
  • exercises greater control over service vendors

By purchasing a Stop Loss insurance policy from the underwriting companies of Transamerica, employers can mitigate the financial risk of funding catastrophic claims and continue to enjoy the benefits of self-funding.

Stop Loss Insurance

Policy includes:

  • Specific deductibles from $15,000 to $1,000,000
  • Comprehensive range of contract claims basis: 12/12, 12/15, 12/18, 12/24, 14/12, 15/12, 18/12, 24/12, Paid
  • Expedited reimbursement on specific claims
  • No "experimental" treatment exclusion

Optional Features

  • Aggregating Specific Benefit
  • Specific and Aggregate Terminal Liability Benefit
  • Aggregate Accommodation Benefit

Underwriting Highlights

  • Reliable, consistent and flexible underwriting
  • Direct contact with Managing General Underwriters (MGUs)
  • Specific and aggregate insurance available for medical and prescription drug costs

About Transamerica

Transamerica affiliates and its predecessors have provided Stop-Loss insurance since 1975 through regionally located MGUs, averaging 20 years of experience.

Product Highlights
Minimum group size of 51 employees
Consultative pricing includes "no new laser" option for subsequent policy period
PPO, UR, LCM and Reference-based pricing
Market competitive Excess Loss Contract
Downloads
Agent Onesheet
 

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CSL01A-1015
Agent Use Only.
This is a brief summary of Stop Loss insurance. Policy Form Series SL40A and SL40C. Forms and numbers may vary. Insurance may not be available in all jurisdictions. Limitations and exclusions apply. Refer to the policy, certificate and riders for complete details. Additional