Choosing the right stop loss carrier can mean the difference between protecting your self-funded plan and leaving yourself open for unpleasant (and expensive) surprises. Whether you’re researching potential carriers or getting ready to renew your current contract, here are five questions you should ask.
5 questions to ask potential stop loss carriers
1. Does the carrier offer an advance funding option for catastrophic claims?
Stop loss policies are designed to reimburse employers who self-fund their employees’ health care plans. But in order to be reimbursed, the employer first has to pay the claim. If that claim is unexpectedly large, covering the costs—and then waiting weeks for reimbursement—can be challenging if you’re operating on a limited budget or slim margins.
Advance funding can expedite the reimbursement of expensive claims by streamlining and accelerating the payment process. Your finance team will be happy to see consistent cash flow, despite the large claim incidence. But keep in mind that advancement policies vary by carrier. After you confirm that a carrier offers advance funding, find out if they charge extra for this feature, how quickly they can make funds available, and whether it’s offered only at their discretion and contingent on renewing with them.
2. Can I easily access information about my policy?
Imagine you need a report or you want to check on the status of a claim. With some carriers, it can take days or even weeks to track down the right person or the information you need.
That’s why you should look for a carrier that lets you administer your policy online. These carriers make it easy to run reports, download forms, check the status of claims in real time or submit electronic payments whenever it’s most convenient for you—day or night.
3. Will I have a dedicated service team?
When you have a question or need assistance with implementation, who will be there to help? Some carriers are too small to have an expert team available, or they just rely on their general call center agents. A dedicated service team can provide consistent, knowledgeable assistance.
A one-on-one relationship with a service team that specializes in claims, account management and renewal coordination ensures that your needs are addressed expertly and efficiently, year after year.
4. Will the policy mirror my plan document?
Some carriers include language in their policies that could conflict with your plan, leaving you with potential gaps between what your plan covers and what they will pay. This could include “usual, customary and reasonable” provisions and what they consider to be “medically necessary” treatments.
Ask if the carrier’s policy automatically mirrors your plan document or if mirroring requires a policy amendment subject to underwriting approval. Without a mirroring provision, policy definitions and exclusions could lead to coverage gaps or other reimbursement obstacles.
5. When can I expect a quote or renewal proposal?
When you’re trying to plan ahead for the next fiscal year, you can’t wait until the last minute to find out what your stop loss policy will cost. Timeliness is essential, and quality stop loss carriers should be able to offer a proposal three to four months before the policy year starts.
When it comes to stop loss carriers, it pays to do your homework. While every stop loss policy serves the same general purpose, your experience—and expenses—can vary deeply depending on the provider you choose. Be sure to ask the right questions and review the policy carefully before you make a decision.