Category Archives: Illuminating Industry Jargon

Normalizing Mental Health-The Benefits for Self-Funded Plans

Employers have to walk a fine line around employee mental health. It’s not appropriate for employers to probe their employees with personal questions about their physical or emotional health. At the same time, employers have a vested financial interest in making sure that members of their workforce have access to necessary mental health resources. Continue Reading >

Woman with red nails and a red coffee cup next to her at an outdoor cafe. Mental health.

Aggregate vs Specific Stop Loss Insurance

While stop-loss coverage has become an increasingly popular tool for self-insured employers, it’s still a topic of confusion for many people. The purpose of stop-loss coverage is to provide a layer of financial protection for employers. Two primary types of stop-loss policies exist, aggregate and specific, and employers typically use both types to give themselves maximum financial protection. Continue Reading >

A stop-loss provision as part of an employee health insurance plan helps control employer healthcare costs. Employee’s child receiving medical care during the holidays.

Personalized Medicine: The Future Has Arrived

What if a simple blood test could predict your future? It’s a very real possibility, thanks to personalized medicine, also called precision medicine. Under this model, each patient’s medical care is completely customized and tailored to his or her DNA makeup. Personalized medicine can’t predict a person’s medical future with 100% accuracy, but it can help doctors identify potential roadblocks in their patients’ futures and develop treatments to target those roadblocks. Continue Reading >

A Helpful Guide to Stop Loss Insurance Industry Jargon

Insurance industry terminology can be confusing and overwhelming. In addition, Stop Loss insurance has its own set of jargon that can add to the potential confusion. We've come up with a list of terms you may come across when researching Stop Loss insurance to eliminate any confusion around insurance industry terms. Continue Reading >

Claims and Policy Management: What we do and why it is important

Stop loss insurance provides protection for your organization in the face of a catastrophic claim.   But, how do you know your claims are being paid correctly and your organization is being reimbursed the maximum amount? Your organization can certainly manage its own claims and policy, but working with an experienced broker is benefi Continue Reading >

Contract Periods: Run-in and run-out provisions

What will happen if a claim occurs during the first policy’s effective dates but is not billed until the second policy’s effective dates? Without proper planning you may not have anyone to turn to pay that bill. To solve this problem, run-in contracts and run-out contracts are available. Essentially you can create some overlap between your previous and new policy to cover any claims incurred in the few months surrounding your contract change date. 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.