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Stop Loss Solutions

How do you manage the risk and cost of your benefit offerings while maintaining a strong employee benefit program?

It’s a balancing act self-insured employers understand well. Stop loss coverage protects your organization when catastrophic claims arise. However, not all coverage is the same. Contract terms and conditions can vary significantly. The MMA Stop Loss Advisory Practice can help you get the most out of your stop loss contract terms.

24

%

of employers have had a stop loss claim over $1M. (2)

86

%

of employers will have a stop loss claim each year. (2)

$40M

is the largest known claim for stop loss. (1)

Data source:

1. FDA.gov Jan. 15, 2019 News Release  
2. 2020 Sun Life Stop-loss Research Report: High-cost Claims and Injectable Drug Trends Analysis

Benefits of Stop Loss Solutions

The MMA Stop Loss Advisory Practice helps you consider all your options.

  • Decide when indexing your deductible may be appropriate to stay in line with market trends
  • Understand the value of contract differences beyond the standard no new laser with rate cap conversion
  • Help contain and manage high-cost claimants like new gene therapies with emerging solutions
  • Identify current policy gaps
  • Determine when plan design changes can increase your exposure
  • Figure out when a captive solution may be a good fit

 

Stop Loss Solutions Features

By working with the MMA Stop Loss Advisory Practice, your company gains access to industry experts that can help you identify highly favorable stop loss terms and conditions.

Contract Negotiations

We handle vendor negotiations to deliver advantageous contractual terms at aggressive premium levels.

Full Claims Support

We offer full claims support including tracking potential high claimants, submission to the vendors using automated file feeds, and processing timely payments.

Deductible Modeling

We use the Claros Model to show optimal specific deductible levels using historic claims.

Limited Liability

We utilize quality review processes and procedures to help limit the liability associated with stop loss.

Relevant Benchmarking

We complete benchmarking at national, regional, industry, and employee-size level.

Market Leverage

We provide fact-based market leverage based on MMA’s entire book of business for both marketing and claims escalation.

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