STOP LOSS

 

First Symetra National Life Insurance Company of New York is dedicated to helping self-funded groups reduce their medical claim costs and has the expertise needed to deliver results.

QUICK FACTS

  • Minimum group size: 100 eligible employees
  • Specific advance funding: Standard on all policies
  • Lasers: No new lasers or increase on existing lasers upon renewal


WHY STOP LOSS?

Medical stop loss helps groups with self-funded medical plans cap their risk while providing the flexibility needed to meet today's health care challenges.

 

THE FIRST SYMETRA ADVANTAGE

A best-in-class policy
The First Symetra policy mirrors the employer's plan document without internal limits or definitions that may conflict with the plan. We do not have provisions in our policy like late enrollee wording, medical necessity or experimental/investigational definitions.

Outstanding claims support
We work with out TPA and cost-containment partners to help claimants receive the best possible treatment with cost savings. Our team of registered nurses assist with high-risk events such as treatment for kidney disease or hemophilia, transplants and premature births.

Fast, accurate claims handling
Most specific stop loss claims are reimbursed within five working days of receipt. Aggregate claims payments also average five working days.

Technical referral assistance program
This unique program helps determine—in advance—how a claim will be reimbursed under a First Symetra stop loss policy. Clients receive a written reimbursement position prior to a Specific or Agregate claim thereby avoiding delays at the time of reimbursement.

National and regional health care programs
First Symetra provides voluntary access to many of the nation's transplant centers of excellence through our partner vendors.

Fairness and partnership
Our policy is to act fairly and responsibly toward policyholders. We won't terminate or non-renew a stop loss policy because of poor claims experience.

 

COVERAGE TYPES

Specific Stop Loss Coverage
Helps protect against catastrophic claims above the specific deductible.

Aggregate Stop Loss Coverage
Helps protect a self-funded plan in the event that actual claims for a group exceed planned, budgeted claims.

 



First Symetra Stop Loss (filed as the Excess Loss policy) is insured by First Symetra National Life Insurance Company of New York, New York, NY.