Stop Loss for Health Plans

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Medical Stop Loss Insurance

We believe your coverage should work for you, not against you.

Cigna Stop Loss insurance helps medium to large self-funded (ASO) employers balance today’s high-risk climate with high-speed reimbursement.

What is it?

Individual Stop Loss (ISL) is a stop loss policy written in conjunction with an ASO (self-funded) medical plan, limiting the client's liability on each individual for each policy year to a set dollar amount (i.e., pooling point).

Aggregate Stop Loss (ASL) is a stop loss policy written in conjunction with ASO (self-funded) plans to help protect a client's financial resources from an unexpected increase in overall claim utilization.

For Cigna Level FundingSM and Graded Funding clients, Individual and Aggregate stop loss are automatically included in order to help protect the client from unexpected claim costs.

How it Works

Stop Loss insurance works directly with your self-funded (ASO) medical plan. Terms and definitions are fully aligned to help keep you safely protected against catastrophic costs that can significantly impact your claims liability.

  • Consistent coverage. 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. We retain 100% of the risk. Covered claims are reimbursed automatically with no claim filing or notification necessary.
  • High-speed reimbursement. Over 93% of stop loss claim dollars are reimbursed within 48 hours and 99% are reimbursed within five days.1 Reimbursements above $150,000 are expedited for same-day service and will typically reach your bank account before the health care professional payment is withdrawn.
  • 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 Options

We can offer a paid contract, run-in, run-out and other standard options you’re used to seeing in the marketplace, but we specialize in unique contract options engineered to satisfy your needs.

Incurred Contract is a great example of the flexibility we have to work with you. It was designed with an infinite tail; even if claim payment spans contracts, all eligible stop loss insurance claims incurred during the policy year will accumulate together with no pooling point reset.

  • Eliminate claim payment timing issues
  • Secure an infinite terminal liability protection period
  • No maturation adjustment at first renewal

You can always choose to take on more risk for a lower rate. Depending on coverage needs and your comfort level for risk-sharing, Tiered Pooling and Aggregating Specific options are available for employers who wish to add an additional layer of liability.

A Firm Quote You Can Count On

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. No matter what might appear beyond the horizon, 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.
  • No last-minute lasers will be applied, even if reporting turns up something new after you lock-in but before your policy start date.

A Renewal You Can Trust

We understand that a straightforward proposal can be hard to come by in today’s marketplace, which is why we provide options that make budgeting simple.

Renewal Advantage. If you are concerned about your level of risk or you’re new to self-funding, Renewal Advantage can limit your future exposure by giving you the option to cap your renewal rate increase.

  • No new lasers will be applied for high-dollar claimants
  • No pooling point increase will be required
  • Renewal rate increase will be capped at 45%

Note: for those on a paid contract, maturation may apply at first renewal.

Your Stop Loss Team

We help employers keep their stop loss connected under the same umbrella as medical, while still operating as our own entity in order to provide streamlined service and maintain unbiased oversight.

  • Stop loss underwriters will listen to your concerns, point out potential pitfalls of coverages you’re comparing and highlight untapped opportunities you may want to consider during the quoting process.
  • Stop loss contract analysts will personally oversee the install of your plan and consult on your case all year long.
  • Stop loss account managers know you and your account details for the day-to-day operations of your account.

Resources

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

To schedule a session, please email us.

1Cigna analysis based on claims data from 01/01/2013–12/31/2013. December 2014.

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

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.