Most insurance policies leave little room for negotiation other than coverage amounts and deductibles.  Riders are a way to separately purchase additional benefits to customize your policy.  Stop loss insurance is a way to limit financial risk so the riders associated with it are for financial benefit, not health benefit.

For example, you may be able to tailor your plan to include some/many of the following features:

To prevent the risk of tying up cash for a high dollar catastrophic claim, you may be able to select a rider that provides for the insurance company to directly pay the claim to the health care provider instead of reimbursing the plan at the end of the month.  This is called Advanced Funding.

Another available rider, known as Aggregating Specific, is one in which your company can reduce premium payments by paying a portion of the stop loss claims out of pocket.  This choice has inherent risk so it is only prudent for plans with strong financial footing.

When changing providers or reverting to full insured health insurance, the issue of incurred vs claims pay dates and contract start vs contract end dates arises.  There are options for riders that will address this issue.  One rider option , called Terminal Liability, is to extend the date until which claims will be paid on the current contract.  In this case claims at the end of a stop loss policy will be paid by the outgoing insurance policy.  Another approach is a rider on the incoming insurance policy to cover previously incurred but not yet paid claims.  This is known as a Run-in contract.

Rate increases can be capped with a rider so that companies will be able to predict expenses further than 12 months.


If you have questions about your stop loss insurance plan or the riders that are available in the market, please contact us.