Protection for self-funded benefit plans
Stop Loss Insurance
Employers today have more choices than ever before when it comes to providing employee health care. One basic decision is the best way to finance this expense. Employers offering health benefits have two choices:
- Fully insured – With a fully insured plan, employers pay a fixed monthly premium to an insurer, which processes and pays for the empoyees’ claims.
- Self-funded – With a self-funded plan, an employer covers the cost of the employees’ claims and pays a fee to an administrator to process the claims.
Employers who self-fund can gain flexibility, improved cash flow, and lower expenses and taxes. Self-funding is a popular choice — 63% of U.S. employees with employer-provided health coverage in 2015 were part of a self-funded plan.1
Most employers don’t have the financial resources to cover large claims that occur, so they purchase Stop Loss insurance to limit their liability. With Stop Loss, employers pay a predetermined amount for employee health claims. Any amount beyond that would be reimbursed by the Stop Loss policy. This protection can be a lifesaver for businesses that can’t afford the expense of an unexpected or catastrophic claim.
The Berkley Advantage
Berkley Accident and Health offers Stop Loss protection designed with employers in mind:
- Options for your plan – You can choose your deductible level, benefit period, and covered benefits.
- Flexibility to tailor your plan – You can choose from flexible options to customize a plan for your number of employees, risk tolerance, and financial goals.
- Fast, responsive claims service – You’ll receive claim reimbursements quickly, including electronic deposit, so you won’t be caught with cash flow problems. We also provide cost-containment support that can help lower health care costs even before a claim occurs.
Best of all, our solutions are backed by the financial strength of an A+ rated insurer that is also a Ward’s 50 Top Performer for safety and consistency.2 You can rest assured, knowing that Berkley has the strength and resources to pay even the largest of claims.
And for Stop Loss brokers, Berkley offers specialized compensation programs for select broker partners.
- Protects employers from claims that exceed a predetermined dollar amount (deductible) for any one individual. Typical claims include: cancer, premature births, transplants, and traumatic injuries.
- Client-focused support to keep your plan on track
- Tools for insurance professionals
- Protects employers from higher-than expected claims for the entire group. Typical claims include: a large number of employees who receive more frequent medical care in a given year that are below the Specific deductible.
- Services to help lower the cost of catastrophic claims
- Stop Loss coverage for union groups
Is self-funding right for your organization? Learn if your group is a good candidate and the pros and cons of self-funding.
Organ and tissue transplants are a major concern for self-funded employers. Berkley Accident and Health offers a next-generation program that can make transplant costs more predictable.
12015 Employer Health Benefits Survey, Kaiser Family Foundation, www.kff.org.
2Berkley Life and Health Insurance Company, rated A+ (Superior) by A.M. Best and a Ward’s 50 Life-Health Top Performer.
Insurance coverage is underwritten by Berkley Life and Health Insurance Company and/or StarNet Insurance Company, both member companies of W. R. Berkley Corporation and both rated A+ (Superior) by A.M. Best. Not all products and services may be available in all jurisdictions, and the coverage provided is subject to the actual terms and conditions of the policies issued. Payment of claims under any insurance policy issued will only be made in full compliance with all United States economic or trade and sanction laws or regulation, including, but not limited to, sanctions, laws and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (“OFAC”).