Stop Loss for Health Plans

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Cigna Medical Stop Loss Insurance

Stop loss insurance helps protect your company from the unexpected.

Protecting your company financially is critical during these uncertain times.

If you have a self-funded medical policy, stop loss can help keep your business covered as the future of health care evolves. It can help you save money and improve health outcomes, while minimizing financial risk to your company.

When you choose Cigna as your stop loss carrier, you can be confident your company will be protected from today’s growing risks, such as high cost claims, new costly drugs and treatments, and more.

Cigna Stop Loss Insurance Policies

Individual Stop Loss (ISL) is a stop loss policy written in conjunction with a self-funded medical plan, limiting the employer’s liability on each individual to a set dollar amount per policy year.

Aggregate Stop Loss (ASL) is a stop loss policy written in conjunction with a self-funded plan, limiting an employer’s liability for their entire covered population to a set dollar amount per policy year. For small to medium sized employers, Cigna Level FundingSM and Graded Funding include Individual and Aggregate stop loss automatically.

How Stop Loss Insurance Works

Stop Loss integrated with a self-funded medical plan ensures alignment between policies and enables:

  • Consistent coverage. Eligibility and terms such as medical necessity and experimental and investigational treatment are consistent between your medical plan and stop loss policy, ensuring identical coverage decisions.
  • Simple claim management. Covered claims are reimbursed automatically with no claim filing or notification necessary.
  • High-speed reimbursement. Reimbursements are processed within two to five calendar days from claim payment, and large claims over $150,000 are often credited same day or before the provider payment debit.1
  • Portfolio management tools. Receive advance notification when stop loss reimbursement has been scheduled for large claims, which will indicate dollar amount and estimated settlement date.2

Contract Types

Incurred Contracts

We offer an Incurred Contract with an infinite terminal liability protection period where claims accumulate to stop loss limits based on the incurred date (i.e. date of service). With this contract type, eligible claims incurred during a policy year will accumulate together with no pooling point reset, regardless of when the claim is paid. The incurred contract is available with ISL and ASL, and:

  • Eliminates coverage gaps related to claim payment timing
  • Eliminates the need for run-out protection or run-in with a new carrier
  • Eliminates the need for a maturation adjustment at first renewal

Paid Contracts

We offer a Paid Contract where claims accumulate to stop loss limits based on the paid date. The paid contract covers eligible claims paid during the active policy year, so long as the claims were incurred after the original policy effective date. The paid contract is available with ISL and ASL.

Contract Options

We also offer additional stop loss contract options designed to satisfy your unique coverage needs.

  • Run-in and Run-out Protection: For employers transitioning to and from stop loss carriers
  • Tiered Pooling and Aggregating Specific: Options for employers willing to take on more risk for a lower rate
  • Renewal Advantage: Available for employers seeking to limit future exposure by capping the renewal rate increase at 45%3, and eliminates new lasers and pooling point increases at renewal
  • Dividend Option: Gives employers an additional refund if they have good claims experience for one, two, or three years

Reliable Firm Quotes

Upon accepting our firm quote — up to six months in advance — your rates, terms and conditions become final and your premium for the policy period may never increase. We take on 100% of the covered claims liability.

Some firm quotes in the marketplace may only be willing to lock-in rates, which could leave room to alter other terms and conditions closer to the start date of your policy. We think you deserve a guaranteed rate and honest terms.

  • Our early lock-in ensures that rate, terms and conditions are finalized — with no need for review of updated large claim information as your policy start date approaches.
  • Signed disclosure forms are never required, even when you have employees with ongoing large claims.

Training and Continuing Education

Cigna offers stop loss training courses for brokers and consultants seeking continuing education credit. We can also tailor an interactive session for employers that wish to learn more about self-funding and stop loss insurance.

To schedule a session, please contact your local Cigna Sales Representative.

1Cigna analysis based on claims data from 1/1/19 – 6/30/19, July 2019.

2Stop Loss Reimbursement Notifications are issued for claims with medical payouts of $250k+.

3For those on a paid contract, maturation may apply at first renewal.

Policy provisions and availability may vary by location and is subject to change. All stop loss insurance policies and group benefit plans contain exclusions and limitations. For costs and details of coverage, contact your Cigna representative.