Stop Loss Insurance for Municipalities

For self-insured cities and towns a stop loss insurance specialist like Stop Loss Insurance Brokers, Inc. works with your current insurance broker or consultant to provide you with additional options that could save you money or provide you with better insurance for your current rate.

We are an experienced broker providing medical stop loss insurance to more than 50 cities and towns in New England. In addition to negotiating a competitive price for your insurance, we also service the account with excellent claim reporting and reimbursement services.

Because insurance carriers come and go in the medical stop-loss marketplace, it is extremely important to choose a company that’s financially sound, experienced, and reputable. Stop Loss Insurance Brokers, Inc. will only recommend policies from A rated carriers that know  the MA Municipal Health Care Laws (MA General Law , Chapter 32B)  and other state municipal laws.

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How to solicit competitive bids for stop-loss insurance as part of your city/town’s self-funded employee health plan

Increasing costs and declining budgets mean it’s time to take a look at each expense that crosses your desk to be sure you’re maximizing the value of every dollar. One idea you may not be taking advantage of yet is to seek competitive quotes for your stop loss insurance separately from your health insurance.

For self-insured cities and towns a stop loss insurance specialist works with your current insurance broker or consultant to provide you with additional options that could save you money or provide you with better insurance for your current rate.

Step 1

Speak with your current insurance broker or consultant to ask for assistance in creating an RFP for stop loss insurance.

Step 2

The information required to solicit competitive bids includes your:

  • Current census
  • Plan description
  • List of high cost claims over 50% of your specific deductible with diagnosis and prognosis information
  • Current stop loss coverage information including current deductible, terms, and rates

Step 3

The timing for the RFP distribution should be 60-90 days before your annual insurance renewal date.

  • Generally allow stop loss brokers 14 days to receive and present competitive bids
  • Invite stop loss brokers to present and explain competitive bids

Step 4

Qualitative considerations when making your final decision should include account service issues such as:

  • Claim reporting and tracking of claims
  • Reimbursement services
  • Track record of working with cities/towns

Step 5

Upon choosing a stop loss insurance broker/carrier to work with you will review the insurance plan options and make a selection based on coverage and cost.

Step 6

When renewal time comes, your stop loss insurance broker will provide you with updated quotes for your consideration and selection.

For Municipalities

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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.