Category Archives: Firm News

How COVID is Impacting Claims for the Self-Insured Employer

Though the worst of the COVID crisis is over, it may be several more years before American employers realize its full impact on employee health claims. The pandemic created conditions that kept some people from accessing necessary medical and mental health care. Soon, both those patients and their employers may pay the price. While some self-insured employers saw their claims drop at the height of the crisis, COVID may still have a wave of high-cost claims in store. Continue Reading >

There were a lot of reasons why people put off preventative medical treatment during the early days of the pandemic. This cardiologist has a red stethoscope over her shoulders.

Why Workplace Wellness Programs Fail—and What to do Instead

When workplace wellness programs work, it’s a true win-win. Employees get access to the resources that help them take care of their physical and mental health, allowing them to do their most productive work and live their best lives. Employers, in turn, benefit from having a healthy workforce—especially self-insured employers, who only pay for their employees’ real medical claims. The healthier its employees are, the less the employer pays in health costs and absenteeism. Continue Reading >

Direct Contacted Medical Services for Self-Funded Employers

When a Walmart employee needs an organ transplant or spinal surgery, they don’t go to their local hospital. If they’re enrolled in the company’s benefits program, all Walmart associates can go to the Mayo Clinic for certain surgeries—with Walmart footing the bill. The company has a contract with the Mayo Clinic to provide services to its employees, and has similar contracts with other health systems throughout the country.  Continue Reading >

Child having his throat looked at by a masked doctor. There are a few ways that smaller businesses can cut costs by using direct contracted medical services.

What Employers with Self-Funded Plans Should Know About High-Value Claims

In a largely unpredictable world, some things are constants. Housing prices and college tuition will rise every year. So will healthcare costs. Each year, more and more Americans incur high-value medical claims in excess of $500,000. For self-insured employers to accurately plan ahead, it’s important to have some idea just how much and how quickly those major claims will rise. Stop Loss Insurance, Inc. has been tracking self-funding trends for our clients for many years. Back in 2014, we broke down data from Highmark, Inc. on high-value claims to help our clients understand the current landscape. Six years later, the numbers have changed but the trends remain the same. Here’s what you need to know. Continue Reading >

high-value claim

Opioids and the Issue of Rehab

As lawmakers work to improve the quality of healthcare and preventative solutions, the American healthcare system is left with holes that do not address the growing opioid epidemic. As opioid abuse increases, the number of self-funded employers footing the bill for drug abuse issues of employees goes up as well. Self-funded employers need to know how to protect themselves in the current political climate, should this situation arise. Continue Reading >

Denise Doyle Presents Awards to 2014 Sun Life Rising Stars

Denise Doyle, President of Stop Loss Insurance Brokers, Inc., was selected by Sun Life Insurance to announce and present prize awards to the 2014 Sun Life Rising Star Award winners.  The ceremony, held at the TD Bank Garden on Monday, November 17, before a Celtics game versus the Phoenix Suns was highly attended by the business community, the families of the winners, and the media. Continue Reading >


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    In 2011, the top 5 most expensive medical conditions treated in US hospitals were: Septicemia, Osteoarthritis, Complication of device, implant or graft, Liveborn, and Acute myocardial infarction

    From 2010 to 2013, the number of claims that were individually $1 million or above rose by 1,000%

    In 2017 approximately 18% of the American public will purchase insurance through exchanges, radically transforming the health insurance landscape.

    In 2014, 98% of large firms (= 200 Workers) offer 1+ wellness programs to their employees.

    The most costly 1% of patients account for 20% of national health expenditures – accruing average annual expenses of nearly $90,000 per person.

    6% of firms offering fully-insured plans report they intend to self-insure because of Obamacare.

    In 2014, PPO plans remained the most common plan type, enrolling 58% of covered workers.

    In 2012, 93% of businesses with 5,000+ employees and 80% of companies with 1,000-4,999 employees were self-funded

    Massachusetts has the third-highest prevalence of self-funded insurance in the small-group market (Fewer than 50 employees).

    In 2013, the average deductible was $2,906 for individuals selecting plans from marketplaces. This compares with average deductibles of $1,135 for an individual with employer coverage.

    In 2013, the average annual premiums for employer-sponsored health insurance are $5,884 for single coverage and $16,351 for family coverage, up 5% and 4% respectively from 2012.

    From 2010 – 2013, cancer followed by chronic/end stage renal disease and leukemia accounted for the top 3 costliest illnesses.