Employer Stop-Loss Coverage

Self-funded employers can exercise control over escalating healthcare costs through better plan design development, cash flow improvement and more cost-effective claims payment. Employers can also protect against unforeseen catastrophic claims by purchasing stop-loss protection.

Summit Re

Summit Re offers you expertise in managed care and a range of options to help you manage catastrophic claims. The employer stop-loss coverage we offer is underwritten and issued by Companion Life Insurance and North American Specialty, which are rated A+ by A.M. Best. Together, we focus on HMOs offering self-funded benefit programs. Summit Re even has experience assisting clients as they first enter the self-funded market.

Product Offerings

Specific stop loss provides insurance protection against a high claim on any one individual. If covered medical losses exceed the individual's specific retention, the employer is reimbursed for the amount in excess of the specific retention.

Aggregate stop loss offers protection when claims for the entire group are greater than a specified amount. In the event that claims exceed the aggregate limit (typically 125% of expected claims) within a specified time period, the employer will be reimbursed for amounts in excess of the aggregate limit.

Managed Care Expertise

Summit Re specializes in pricing and underwriting excess risk in a managed care environment. Based on years of experience in this market, we've developed appropriate tools to underwrite the business. We use our HMO excess loss expertise to fully reflect your managed care efforts in our stop-loss rates. We also incorporate hands-on client visits, strategy discussions with key contacts and a comparison of the plan's network with the marketplace. We use all of this information to refine pricing and underwriting within the working environment. As a result, you receive competitive stop-loss rates and factors for your clients.

Achieve Peak Performance

The Summit Re team can be a powerful advantage in managing catastrophic risk needs and meeting your financial and risk goals. Let us help you reach new heights. Call us at (260) 469-3000.

Employer Stop-Loss Options

Specific Stop Loss features the following options:

Run-In Protection
Family Retentions
Terminal Liability
Aggregating Specific
Coinsurance Specific

Run-in Protection
Three months of run-in protection are available on specific coverage up to the specific retention amount.

Family Retentions
If claims for one or all family members exceed the specific retention for that policy year, all eligible claims for all family members will be reimbursed for that policy year without needing to meet another retention.

Terminal Liability
This coverage provides 90-day run-out protection for employer groups terminating their self-funded contracts at the end of the policy period and who are returning to fully insured coverage. This option is elected at the beginning of the policy year and is elected only once during the lifetime of the policy.

Aggregating Specific
This option lowers the rate of the specific premium by creating an additional employer liability pool. As charges exceed the specific retention, they aggregate in this pool. Charges become eligible for reimbursement once the pooled amount has been satisfied.

Coinsurance Specific
This option allows the employer to save premium dollars by paying a certain percentage of claims that exceed the designated specific retention.

Maximum Limits (Specific)

$1M is our standard option. Additional maximums are available up to $2M per policy period and $5M lifetime to new groups or at renewal.

Aggregate Stop Loss features the following options:

Run-In Protection
Terminal Liability

Run-in Protection
Three months of run-in protection are available on aggregate coverage up to 15% of the annual aggregate attachment point. Only claims under the specific retention apply to the aggregate attachment point.

Aggregate Terminal Liability
Similar to the specific terminal liability option, this provision allows the employer an additional 90 days for the payment of claims when coverage terminates at the end of the policy period and the employer group returns to fully insured coverage. This option is elected at the beginning of the policy year and is elected only once during the lifetime of the policy.

Maximum Limits (Aggregate)

$1M is our standard option. Additional maximums are available up to $2M per policy period.

Medical Conversions

Medical conversions allow an individual whose coverage terminates to convert to an individual medical policy, subject to certain conditions and exclusions. This conversion policy, available through Celtic Life Insurance Company, requires no evidence of insurability.

Get a Quote

To get an employer stop-loss quote from Summit Re, just print this Request for Proposal form, fill it out, and fax it back to us at 260-469-3014, or contact Chris Alexander (Eastern US Region) at 704-544-9428 or Allen Engen (Western US Region) at 673-497-0804. You’ll hear from us promptly.

Corporate Office Regional Offices

7030 Pointe Inverness Way, Suite 350
Fort Wayne, IN 46804
260.469.3000
FAX: 260.469.3014 6200 Shingle Creek Parkway, Suite 155
Minneapolis MN 55430
763.432.9269
FAX: 763.432.9323

1366 Preserve Circle,
Golden, CO 80401
720.746.1366
FAX: 720.746.1613

414 Old Hard Road, Suite 106,
Orange Park, FL 32003
904.269.5618
FAX: 904.269.5619

13612 Pacific Echo Drive,
Charlotte, NC 28277
704.544.9428
FAX: 704.544.9285