Title: Stop-Loss Insurance Procurement and Audit Source: https://ethosbenefits.com/services/stop-loss Publisher: Ethos Benefits Summary: Ethos Benefits markets, places and renews stop-loss coverage for self-funded health plans, and audits the contract so the policy pays when it should. 1. [Home](https://ethosbenefits.com/) 2. [Services](https://ethosbenefits.com/services) 3. Stop-loss procurement. # 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. [Request a Strategic Analysis](https://ethosbenefits.com/strategic-analysis) ## 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. 1. **Marketing to carriers** Underwriting data assembled and sent to qualified carriers, with every quote compared on terms as well as price. 2. **Contract review** Each policy checked against a fiduciary checklist: lasers, contract basis, terminal liability, exclusions, disclosure requirements and reimbursement timing. 3. **Negotiated protections** Terms such as a no-new-laser provision and renewal rate caps negotiated before the policy is bound, where the market allows. 4. **Placement and renewal** The policy placed for the plan year and remarketed or renewed on the same schedule every year. 5. **Audit** Reimbursement claims tracked from filing to payment, and the policy terms checked against how claims were actually handled. 6. **Large claim monitoring** Large 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](https://ethosbenefits.com/services/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™](https://ethosbenefits.com/fiduciary-framework) · [How fiduciary governance works](https://ethosbenefits.com/services/fiduciary-governance) ## Related reading. - [**How does stop-loss insurance work?** Benefits 101: How stop-loss insurance works for self-funded health plans: specific vs. aggregate coverage, attachment points, contract types, lasering and cost.](https://ethosbenefits.com/benefits-101/stop-loss-insurance) - [**What is aggregate stop-loss insurance?** Benefits 101: Aggregate stop-loss caps a self-funded plan's total claims for the year. How the aggregate attachment point is set, monthly vs. annual aggregate, and the ASD.](https://ethosbenefits.com/benefits-101/aggregate-stop-loss) - [**How much does stop-loss insurance cost?** Benefits 101: Stop-loss insurance has no list price. See what sets the premium, from the deductible and contract basis to claims and lasers, and how employers lower it.](https://ethosbenefits.com/benefits-101/stop-loss-insurance-cost) - [**Stop-loss health insurance examples** Benefits 101: Five stop-loss health insurance examples with the math: one large claim, a bad claims year, run-out under 12/12 and 12/15 contracts, a laser and an ASD.](https://ethosbenefits.com/benefits-101/stop-loss-examples) [Browse everything in Learn](https://ethosbenefits.com/learn) ## 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. ## Keep reading Related to this page. - [**Procurement and contracts** Ethos Fiduciary Procurement is how Ethos Benefits runs RFPs for PBMs, TPAs, stop-loss and other plan vendors, scores every bid and negotiates the contract. _Read more_](https://ethosbenefits.com/services/procurement) - [**Claims analytics** Your company owns its health plan data. Ethos Benefits connects your claims and pharmacy data to analytics and reviews it with you every month. _Read more_](https://ethosbenefits.com/services/claims-analytics) - [**Underwriting and rate analysis** Ethos Benefits checks the underwriting behind your renewal, projects claims from your data, and builds premium equivalent rates for self-funded plans. _Read more_](https://ethosbenefits.com/services/underwriting) - [**Pharmacy and PBM** Ethos Benefits reviews your PBM contract and pharmacy spend, finds where spread pricing and rebates go, and helps your committee decide what to change. _Read more_](https://ethosbenefits.com/services/pharmacy-pbm) - [**TPA and administrative contracts** Ethos Benefits runs TPA and ASO procurement for self-funded health plans and redlines the administrative services agreement before your company signs it. _Read more_](https://ethosbenefits.com/services/tpa-procurement) - [**Vendor management** Ethos Benefits holds your health plan vendors to their contracts with service level agreements, performance guarantees, KPI scorecards and quarterly reviews. _Read more_](https://ethosbenefits.com/services/vendor-management) ## 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](https://ethosbenefits.com/strategic-analysis) [Call (407) 803-4710](tel:+14078034710)