Symetra Benefits Blog

Thanks for helping us celebrate 40 years of stop loss!

As 2016 comes to a close, we’d like to thank you for helping us celebrate this milestone anniversary, and wish you a very happy holiday season.

Protecting minimum essential coverage (MEC) plans

MEC plans are becoming increasingly common as employers adapt to the rules and requirements of the ACA. While these preventive-care-only plans generally avoid covering high-cost, catastrophic medical conditions, high usage of the plan by employees can quickly deplete the health care budgets of unprepared employers. Medical stop loss insurance can play a valuable role in keeping frequent claims costs in check.

Read our Inside Track paper to learn more about how stop loss can protect minimum essential coverage plans.

Symetra delivers for you

We help self-funded policyholders control costs without sacrificing quality of care through efficient processes, outstanding customer service and cost-containment support.

• Accelerated reimbursements for catastrophic claims through our preferred ASO claim advance option.
• A technical referral assistance program that lets clients find out – in advance – how a claim will be handled under our policy.
• Regional alignment of claims examiners, medical risk consultants and sales representatives gives us an appreciation of local networks and medical costs to ensure billed charges are on trend with the area.

Read our recent Inside Track article to learn more about the importance of managed care networks and how they affect stop loss pricing.

Medical stop loss: what matters to carriers and employers

In today’s health care environment, many employers are exploring the flexibility and cost-savings associated with self-funding their employee health care plans. Medical stop loss insurance can help protect these employers from the financial risk of catastrophic claims. To find the coverage that best fits a company’s needs, it helps to understand not only what employers should look for in a stop loss carrier, but also what carriers look for when pricing and evaluating the risk they are assuming.

Read our Inside Track article to learn more about some key considerations for self-funded groups. And if you’re ready to request a quote, contact your Symetra representative.

Your business, our expertise

With more than 40 years in the stop loss business, Symetra provides expertise, flexibility and options to help your clients and your business succeed. We can help you bring the best products and services to your clients by:

• Writing stop loss policies that mirror the plan document and eliminate gaps between what the plan covers and what is eligible for reimbursement.
• Practicing fair and consistent underwriting with no new lasers – or increases on existing lasers – at renewal.
• Providing prompt service – most claims are paid within five business days.

Contact your Symetra representative to learn more about how we can put our decades of experience to work for you!

So what is stop loss, anyway?

As a benefits professional, you’re probably well-versed in medical stop loss insurance. But how do you explain how it works to your clients? For groups that are new to self-funding, it can be overwhelming. Fortunately, our new video has you covered. Watch and share Stop Loss 101 to help your clients learn more about the benefits of self-funding and how medical stop loss can help. After all, we don’t just know the road – we helped write the map.

Why Aggregating Specific?

Adding a second deductible to your client’s stop loss policy—known as an Aggregating Specific¹—can help reduce their fixed premium costs. Your client’s may be interested in the Aggregating Specific option if:

• They want to be rewarded in favorable claims years without taking any additional risk.
• They want to offset a renewal rate increase.
• They want to avoid a laser.

To learn more about Aggregating Specific, check out this flyer or contact your Symetra representative.

¹ Referred to as the Individual Advantage deductible in Symetra Stop Loss policies.

Looking for a premium savings opportunity?

Adding an Aggregating Specific deductible to your client’s medical stop loss policy is one way to turn their favorable claims experience into premium savings. Watch this short video to learn more about how it works and why it may be a good fit for your clients.

Managed care networks and stop loss pricing

Managed care networks can help reduce expenses by negotiating prices with facilities, physicians and other providers for covered services. When reviewing network options for your self-funded groups, you may want to consider what carriers look for in a network to ensure you get the best possible pricing for their coverage.

Stop loss carriers consider many factors when evaluating managed care networks, including:

• Claims eligibility
• Claims experience
• Hospital capabilities

Network selection is critical to any stop loss contract, as the discounts offered can greatly impact the overall pricing of the policy. Read our recent Inside Track article to learn more about the importance of managed care networks and how they affect stop loss pricing.

Claims support that makes a difference

Our stop loss claims team is proud to foster a culture of empowerment that allows your clients' to effectively manage their self-funded expenses. In addition to outstanding customer service, we offer:

• Cost-containment support to negotiate the best possible price for any high-dollar treatment that may affect your client’s plan.
• Alternative treatment plan cost/benefit analysis (when appropriate) to determine if potential treatments are the most cost-effective options.
• Technical referral assistance to let groups find out – in advance – how Symetra will reimburse a stop loss claim.
• Accelerated reimbursements through our advanced funding claim option to significantly reduce the wait time for Specific claim reimbursement.

To learn more about how Symetra can help support your clients’ self-funded medical plan, view our claims support flyer.

10 things to consider when requesting a quote

Prospective clients may not know what types of information to provide when requesting a medical stop loss quote from Symetra. Fortunately, we have you covered. Here are 10 things to consider before requesting a quote for prospective clients.

1. How large is the group?
   Look for a group size of 100 or more covered employee lives.
   
   
2. What are the requested plan requirements?
   Ask for a summary of their requested deductible levels, plan maximums, and any other plan requirements.
   
   
3. Do they have prior paid claims information?
   Look for at least 24 months of paid claims and enrollment history.
   
   
4. What large claims information has been provided?
   Request large claims information for the lesser of 50% of the requested Specific deductible, or $30,000 for the current and prior contract periods (including diagnosis and prognosis).
   
   
5. What is the current schedule of benefits?
   Ask for a current schedule of benefits from the group’s plan document.
   
   
6. What is the group’s rate history?
   Be sure to find out the group’s rate history so you can compare while evaluating new quotes.
   
   
7. Have they provided a census?
   Ask for a census that includes details including DOB/age, gender, employee status, plan identification and all zip codes for multiple locations.
   
   
8. Which PPO network(s) will they be using?
   Ask for the current and proposed PPO networks per location and employee (if possible).
   
   
9. Which TPA will be administering the plan?
   Request the name and location of the TPA that will be administering or bidding to administer the group’s plan.
   
   
10. What commission will be quoted?
    Find out what commission will be quoted.

By gathering this information, you can help ensure a more accurate quote. Download a copy of our quoting requirements checklist for future reference, and when you’re ready to request a quote, contact your Symetra representative.

Five questions to ask a potential stop loss carrier

 

Giving the right recommendation means asking the right questions. Help ensure your clients’ self-funded medical plans are properly protected by researching potential medical stop loss carriers. Here are five questions to ask before making a recommendation.

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.

Asking these five questions can help you make an informed recommendation for your clients. To see how Symetra measures up, check out our “Questions to Ask” flyer.

 

Looking for additional product offerings?

We recently rolled out a new solution to help close the coverage gaps left from high-deductible health plans (HDHP). Available in most states, this combination of critical illness, accident and fixed-payment inpatient hospital coverage could be a great complement to a self-funded, or even fully-insured, HDHP. Learn more about Symetra's GapAssist.

GapAssist can provide an added layer of financial protection to help employees with unexpected out-of-pocket costs. Three predesigned packages are available—Base, Classic and Premier. Employers can choose to offer one, two or all three packages to meet the needs of their employees.

To learn how GapAssist can help close the coverage gap for employees, check out our press release or contact your Symetra representative.

The impact of high-cost pharmaceuticals on self-funded plans

Using high-cost pharmaceuticals to treat a range of health conditions is an exciting development for patients and their families but these prescriptions usually come with a hefty price tag.

In this issue of the Inside Track—Symetra’s educational series for benefits professionals—we give a general overview of three high-cost pharmaceutical categories—biologics, specialty pharmaceuticals and compound drugs—and discuss how charges for these types of prescriptions can affect self-funded medical plans.

Limiting the risk with medical stop loss insurance

Did you enjoy the claims video in our last post? If so, you’re in luck. Our 2016 catastrophic claims flyer is now available for download.

Changes associated with the ACA such as the elimination of annual maximums and preexisting condition limitations are likely to keep the frequency of catastrophic claims and the dollar amounts trending upward.

In this flyer we used our own claims data to illustrate how these trends may affect your self-funded medical coverage and why stop loss protection is so essential.

Is your self-funded plan protected?

Watch our new video to see recent trends based on Symetra’s own stop loss claims data. This short overview illustrates how large and catastrophic claims may affect your self-funded medical plan and why stop loss protection is so essential.

Are you surprised by these trends? Let us know what you think in the comments.

Now Playing: 40 Years of Stop Loss

Our stop loss team is committed to ensuring that every interaction you have with Symetra is a good one. Watch this video to learn more about our commitment to this business and yours.   

Symetra Life Insurance Company introduced our first medical stop loss policy in 1976. Developed with employer needs in mind, this coverage was designed to provide financial stability for newly self-funded groups by capping their responsibility for medical claims.

Today, we continue to write stop loss policies with that same ‘peace of mind’ philosophy. As pioneers in the industry, we have decades of experience helping employers, brokers and administrators successfully navigate their self-funded plans.

How long have you worked with Symetra for your stop loss?  Has our product made a difference for your clients?