Stop Loss
Specific Coverage
Specific Stop Loss
What it covers
Specific Stop Loss protects employers from claims that exceed a predetermined dollar amount (deductible) for any one covered individual. Once the Specific deductible has been reached, the Stop Loss policy reimburses an employer for covered medical expenses, helping to protect the employer’s bottom line.
Standard features
- Deductibles from $25,000 to $500,000
- Full range of claims bases
- Cell and Gene Therapy Step-Down deductible
- No Surprises Act benefit – Independent Dispute Resolution
- PBM Checkup
- Advance Risk Commitment – early lock-in for rates up to 90 days
- Simultaneous Reimbursement
- ASO QuickPay – rapid reimbursement available for ASO claims*
- Medical management fees, such as case management, hospital audits, and bill negotiation, eligible for coverage
- Berkley Edge cost-containment services
- No signed disclosure at renewal
*some exclusions may apply
Options
- Aggregating Specific deductible
- Terminal Liability
- Renewal Risk Stabilizer – no new lasers at renewal with rate cap guarantee
- Transplant Risk Stabilizer – reduced deductible for transplant claims
- Policy Alignment
- Group Captive solutions
For more information, contact your Berkley Accident and Health representative.