Questions to ask a potential stop loss carrier

With new entrants to the stop loss market and medical costs on the rise, it’s important to research potential carriers before making a recommendation. Here are five questions to ask to help ensure your clients’ self-funded plans are properly protected.

1. Who actually holds the risk on the paper?
   Some reinsurance treaties are first-dollar percentage arrangements that may require approval before a reimbursement can be made. Make sure you know how many parties are involved in the reinsurance, at what dollar levels, and who is involved in claims decisions.
   
   
2. Has a policy evaluation been completed?
   The definition and exclusion sections of each policy should be evaluated to ensure there are no conflicts between the stop loss policy and the plan the employer wants to provide. This is a critical issue when it comes to reimbursements.
   
   
3. Does the policy contain reasonable (usual) and customary language or stipulations that determine what is considered reasonable and customary?
   Some carriers include reasonable and customary language in their stop loss policies, or they stipulate how reasonable and customary limitations will be determined. This could be in direct conflict to the employer’s plan, potentially leaving the policyholder with a gap between what their plan pays and what the stop loss carrier will pay.
   
   
4. How are reimbursements handled?
   Make sure you know how claims are processed and how quickly they are reimbursed.
   
   
5. How do the firms view their renewal underwriting?
   Inconsistent renewal underwriting could leave the employer with high levels of non-insured risk. Think about what recent experience you have with each carrier regarding renewal underwriting and be sure to ask if they laser at renewal.
   
   

To see how Symetra measures up, check out our “Questions to Ask” flyer.