Stop Loss Insurance

What is stop loss insurance?

Stop Loss insurance puts a cap on the upper-end of what a self-insured employer (business or municipality) pays for health insurance if insurance claims are unexpectedly high from a large number of employees or their families or if one employee is diagnosed with an illness for which the treatments are expensive and ongoing. Not all stop loss carriers or brokers specialize in stop loss insurance. Policies coverage can vary widely so choose a trusted resource to guide you through the process to a plan that meets your needs and your budget.

What is self-funded insurance?

Organizations that are self-insured maintain a fund from which medical insurance claims are paid when employees use their health insurance instead of being fully insured. Self-insuring is a good decision for many medium sized organizations and is the standard for cities, towns, and large businesses. There are risks involved, however, so the decision to self-insure should not be taken lightly.

How can we help?

Considering Self-Funding?

Stop Loss Insurance Brokers, Inc. can assist you in deciding if self-funding is a suitable alternative to your current fully insured health plan.   If so, we can guide you through the implementation of the new plan by introducing you to health insurance brokers for health insurance plans and by quoting  qualified  stop loss carriers that will suit your needs.

Self-Funded Plans

If you are already self-funded and would like some assistance in obtaining Stop Loss Insurance quotes, we can do that.     We partner with the leading insurance stop loss carriers so that we can offer creative, reliable coverage options and competitive pricing.   Once the stop loss program is chosen, we will track large claims and file them with the insurance carrier on your behalf.

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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

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

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

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

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

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

Reference: “2013 Employer Health Benefits Survey”. The Henry J. Kaiser Family Foundation.

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

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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).

Reference: “Self-Insured Health Plans: State Variation and Recent Trends by Firm Size”. Employee Benefit Research Institute, Nov 2012, Vol. 33, No. 11.

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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.

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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.

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

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