Stop-loss procurement. Placement, renewal and audit.

If your health plan is self-funded, stop-loss insurance is what stands between a catastrophic claim and your company's budget. Ethos Benefits markets your stop-loss coverage, compares contracts as well as prices, negotiates protections, places and renews the policy, and audits it so the coverage pays when it should.

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What you get.

Stop-loss quotes are easy to compare on price and hard to compare on what they cover. Lasers, the contract basis and renewal terms decide whether the policy pays when you need it.

Marketing to carriersUnderwriting data assembled and sent to qualified carriers, with every quote compared on terms as well as price.
Contract reviewEach policy checked against a fiduciary checklist: lasers, contract basis, terminal liability, exclusions, disclosure requirements and reimbursement timing.
Negotiated protectionsTerms such as a no-new-laser provision and renewal rate caps negotiated before the policy is bound, where the market allows.
Placement and renewalThe policy placed for the plan year and remarketed or renewed on the same schedule every year.
AuditReimbursement claims tracked from filing to payment, and the policy terms checked against how claims were actually handled.
Large claim monitoringLarge claimants and the plan’s position against its specific and aggregate deductibles reviewed every month.

What a stop-loss contract decides.

Deductibles: the specific deductible for one person, and the aggregate attachment point for the whole plan.
Contract basis: which claims count, based on when they were incurred and when they were paid.
Lasers: higher deductibles or exclusions for named individuals.
Renewal terms: whether rates or lasers can change at renewal, and by how much.
Terminal liability: what is covered if the plan ends or moves to a new carrier.
Disclosure: what the plan had to tell the carrier, and what happens if something was missed.

How we market it.

Stop-loss runs through the same Ethos Fiduciary Procurement process as every other vendor: the underwriting data assembled once, quotes requested from qualified carriers, contracts compared term by term, and the decision documented for your committee.

The audit.

A policy only protects the plan if claims are filed and paid. Ethos tracks each reimbursement from submission to payment, checks the carrier’s handling against the contract, and reports the plan’s position against its deductibles to your committee every month.

Part of your Fiduciary Framework™.

Every Ethos service reports to your benefits committee. The work is reviewed at your quarterly committee meeting, each decision is recorded with the reasoning behind it, and the record lives in your Ethos Fiduciary OS. That is what lets your committee show the plan was run prudently.

See the Fiduciary Framework™ · How fiduciary governance works

Questions employers ask about this.

When should stop-loss marketing start?

Early enough that underwriting data, quotes and contract terms can be reviewed before the renewal deadline. Ethos starts the renewal process at least six months before the plan year begins.

What is a laser?

A laser is a higher deductible, or an exclusion, that a stop-loss carrier sets for one person with a known high-cost condition. Lasers can leave a plan exposed to exactly the claims it bought stop-loss to cover, so they are one of the first terms to review.

What is the difference between specific and aggregate stop-loss?

Specific stop-loss covers claims for any one person above a set amount. Aggregate stop-loss covers total plan claims above an expected level for the year. Most self-funded plans carry both.

What does the stop-loss audit check?

That every eligible claim was submitted for reimbursement, that the carrier paid what the contract requires and on time, and that any denial was consistent with the policy terms.

See what your plan is really costing you.

A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.

Request a Strategic Analysis Call (407) 803-4710