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Stop Loss Coverage

While contemplating the importance of stop loss coverage in the arena of group health self funding a wise person once said:

“It is really nice if stop loss coverage is properly underwritten and insured by financially sound A or A+ rated carriers and includes all of the necessary bells and whistles and is of course the most competitively priced.”

Upon further thoughtful reflection an even wiser person subsequently said:

“Stop loss coverage being the obvious commodity it is remains just a commodity so long as there are no inconvenient bumps along the road such as an actual claim being incurred or any annoying administrative issues cropping up. All is good!”

The inevitable crunch comes when a claim is incurred and/or some other issue arises that actually requires a thoughtful, prompt and correct response. Here are a few examples of some potential “bumps:”

  • A claim is denied for any reason
  • A claim is paid but not in the amount expected
  • Claim payment is delayed with either an inadequate or unacceptable explanation
  • A complicated disclosure issue arises
  • Questions arise relating to eligibility and/or plan document interpretation
  • Resolution is needed involving a possible miscommunication or issue between stop loss claim unit and claims administrator.