Stop Loss Insurance: How it works for your Health Plan

Friends With Your Benefits | John Coleman

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Stop Loss Insurance: How it works for your Health Plan:
We sit down with Mehb Khoja, Chief Actuary at BCS Financial Corporation, to discuss the topic of stop loss.
Stop loss is a critical component of any self-funded health plan, and in this video, Mehb breaks down what stop loss is and how it works.
Mehb explains the concept of leveraged trend and how influences stop loss premium rates, as well as the role of a laser in stop loss coverage.
He also highlights some of the key exclusions to look out for when selecting a stop loss policy, and provides valuable insights into how to ensure that your self-funded health plan is properly protected.
We are discuss the difference between aggregate and individual stop loss coverage.
Whether you're an employer looking to better understand stop loss coverage, or an actuary seeking to deepen your knowledge of this important topic, this interview is a must-watch. Join us as we explore the world of stop loss with one of the industry's leading experts.
#stoploss
#Employeebenefits
#Humanresources

Опубликовано:

9 сен 2024

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Комментарии : 5

@Alexanderjones-ss9uk 11 месяцев назад

Informative video, thanks for sharing.

@FriendswithyourBenefits 11 месяцев назад

Thanks for checking out our video on stop loss

@Nmh8616 8 месяцев назад

What happens when a group terminates a stop loss policy? Can you elaborate on the process of when a claim is incurred, processed, paid through each vendor (TPA, SL vendor).

@FriendswithyourBenefits 8 месяцев назад

This is a good question. There a generally 3 scenarios that can happen with the ISL contract in the event the carrier is termed 1. Contract is written on an incurred 12/24 basis- the terminated stop loss carrier is responsible for claims incurred 12 months during the plan year and runout claims for 12 months after the plan year ends 2. 12/12 contract- if not converted to a paid contract, this is a gap in coverage and the health plan is responsible for any runout claims in the next year. Gaps can also exist in 15/12 or 18/12 contracts as the runout period is 3-6 months 3. Paid 24/12 contract- the new carrier is responsible for run-in claims incurred 12 months prior but paid within the current plan year. In the event of a carrier termination the new carrier would be responsible, for a claim incurred in 2023 but paid in 2024. This is the most common arrangement in the stop loss market place There is also a coverage protection called TLO which can be used by groups terminating their self-Insured plan that want protection against run-out claims in the next plan year.

@Nmh8616 8 месяцев назад

Thank you!