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  • Home Employers Cost Control Strategies Stop Loss Insurance

    Stop Loss Insurance

    Helping to protect your company from the unexpected.

    Building a new benefits package?

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    Financial Protection for the Evolving Health Care Landscape

    During uncertain times, it's critical to protect your company financially. If you have a self-funded benefit plan, stop loss insurance can help keep your business covered.

    Stop loss from Cigna HealthcareSM* can help you save money and protect your cash flow from the growing risk of high-cost claims and new costly drugs and treatments.

    What is stop loss insurance?

    There are two types of stop loss insurance that Cigna Healthcare offers:

    Individual Stop Loss (ISL)

    ISL is stop loss coverage written to protect a self-funded medical plan by limiting an employer's claim liability on each individual to a set dollar amount per policy year.

    Aggregate Stop Loss (ASL)

    ASL is stop loss coverage written to protect a self-funded medical plan by limiting an employer's claim liability for their entire covered population to a set dollar amount per policy year.

    For small to medium-sized employers, Cigna Level Funding® and Cigna Healthcare Graded Funding include Individual and Aggregate Stop Loss automatically.

    Types of Stop Loss Contracts

    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 ISL limit 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.

    Options for Stop Loss Contracts

    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 - for employers willing to take on more risk for a lower rate
    • Renewal Advantage - for employers seeking to limit future exposure by capping the renewal rate increase at 45%1 (eliminates new lasers and pooling point increases at renewal)
    • Dividend Option - for employers who want an additional refund if they have good claims experience for one, two, or three years

    Stop Loss Firm Quotes

    Upon accepting our firm quote, 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. 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.

    Benefits of Integrating Stop Loss With Medical Plans

    Stop loss insurance 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.
    • 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

    Stop Loss Training and Continuing Education

    Cigna Healthcare 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 Healthcare Sales Representative

    *Offered by Cigna Health and Life Insurance Company

    View Cigna Healthcare Company Names

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

    2 Stop 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 Healthcare representative.

    Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company (Bloomfield, CT), or its affiliates. In Utah, all products and services are provided by Cigna Health and Life Insurance Company (Bloomfield, CT). Policy forms: OK – HP-APP-1 et al., OR – HP-POL38 02-13, TN – HP-POL43/HC-CER1V1 et al. (CHLIC); GSA-COVER, et al. (CHC-TN).

    © 2023 Cigna Healthcare.

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    Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of The Cigna Group Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT). The Cigna Healthcare name, logo, and other Cigna Healthcare marks are owned by The Cigna Group Intellectual Property, Inc.

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