The Importance of A Rated Carriers for Stop Loss Insurance

What is an A rated carrier?   A rated carriers include carriers with ratings A- and above.  A carrier’s rating is a measure of the insurer's financial strength and therefore its ability to meet its ongoing contract and policyholder obligations.  To determine an insurer’s rating, a complete evaluation is conducted including its finances, operations, and reputation. 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 >

Subrogation: What Is It & How Can It Lower Insurance Costs?

The insurance industry is saturated with complicated jargon that can be overwhelming to anyone buying insurance. However some of these complex terms found in your policy can save your city or town money. An increasingly popular term that is listed in nearly all self funded plans and stop loss insurance contracts is subrogation. So what is subrogation and how can it lower the cost of your insurance? Continue Reading >

Backdoor Regulation of Self-Funding | Stop-Loss + the ACA

When the Patient Protection and Affordable Care Act (“PPACA”), (now commonly referred to as the  Affordable Care Act, the ACA, or "Obamacare") was signed into law by President Barack Obama on March 23, 2010, both the health benefits and health care industries were abuzz with rumor, conjecture, and fear.  As the dust has settled, we who service these industries have begun to appreciate the real impact the law has had on both the provision of health care, as well as payment for that care. Continue Reading >

Managed Care Vendors: Part of a Self-Funded Health Plan

Most self-funded plans utilize the services of a third party administrator (TPA) or an Administrative Services Only (ASO) carrier to act as the medical claim payer for their self-funded plans.   The services provided by these organizations typically include claims adjudication and benefit plan administration.  The services should also include management of service providers to help lower the cost of claims. Continue Reading >

Impact of Mental Health & Substance Use on Self-insured Plans

The issue of mental health in the United State is significant.  An estimated 26.2% of Americans ages 18 and older suffer from a diagnosable mental disorder in a given year according to the National Institute of Mental Health.  So what should employers know about compliance and the cost associated with mental and substance abuse coverage? Continue Reading >

Experimental Drugs: In Your Health Plan and Stop Loss Policy

Experimental drugs are a proposed treatment for an illness such as cancer that has been tested in a laboratory and has received approval from the FDA to begin treatment on people.[i]   They have many uses that are vital, and often times the circumstances are life and death.  Even so, they are not always covered under all insurance plans across the United States, due in part to the unknown efficacy and cost of the drugs.  If experimental drugs are covered under your plans it is essential to take note in what instances they are covered, specifically clinical trials or off label drug use.  Therefore, if you are choosing an underlying plan (HMO, PPO) or a stop loss policy (for self insured plans) for your employees it is important to know what is covered under each. 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.