Education is key
Managing the risks of self-funding can be challenging. Understanding how stop loss helps safeguard your plan against large or catastrophic medical claims is key.
Here are some questions to consider when partnering with a stop loss carrier.
How are claim reimbursements managed?
- Find out how the stop loss carrier processes claims and how quickly they are reimbursed.
Symetra specific and aggregate claim payments average five business days, and reimbursements can be made electronically to avoid check printing and mailing delays. We also partner with policy administrators to allow direct filing for an easy, expedited process.
Are there conflicts between the policy and the plan?
- The definitions and exclusions sections of each stop loss policy should be reviewed to ensure there are no conflicts between the policy and the plan you want to provide. This is a critical issue when it comes to claim reimbursements.
Our stop loss policy does not include internal limits that might conflict with your plan document wording.
What is the stop loss carrier's renewal underwriting process? Do they laser?
- Inconsistent renewal underwriting could leave you with high levels of non-insured risk. What recent experience do you have with each carrier regarding renewal underwriting?
Symetra does not apply lasers—or increase existing lasers—at renewal, and we never decline a group’s renewal due to poor claims experience.
Who actually holds the risk on the stop loss policy? How many parties are involved in the reinsurance and at what levels?
- Some reinsurance treaties are first-dollar percentage arrangements that require approval before a reimbursement can be made. Who is involved in claim decisions?
Symetra assumes the first $1.7 million of risk before any reinsurance is put in effect. We retain 100% authority over all claim decisions, even those cases over $1.7 million.
Symetra Stop Loss, filed as the Excess Loss policy, is insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004 and is not available in any U.S. territory. Our New York subsidiary insures products for New York policyholders.
As an industry pioneer,
Symetra is known across the nation for delivering outstanding claims support, being a resource for product expertise and issuing a best-in-class stop loss policy that mirrors the employer’s plan document.
The Inside Track Educational Series
Minimizing your self-funded plan's health care risk
Understanding advance funding provisions
The carrier side of stop loss
Managed care networks and stop loss pricing
Resources to keep medical claims in check
Protecting minimum essential coverage (MEC) plans with medical stop loss