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Not all stop loss contracts are created equal. It’s important to shop and compare. |
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“Stop loss shouldn’t be viewed as a commodity, like bread or milk. Yet, far too many professionals base their buying decisions solely on price,” said Jim Brose, regional vice president for Symetra Life’s Group segment. “You wouldn’t buy a car without looking at things like gas mileage, warranties and reliability. Buyers should take the same care when shopping for stop loss coverage.”
Brose suggests agents and their clients undertake a thorough “contract evaluation.” At the very least, the evaluation should include a review of the definitions and exclusions sections of each contract to make sure there are no conflicts between the insurance contract and what benefits the employer wants to provide.
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“This is a critical issue at the time of the reimbursement request,” said Brose. “SymetraSM Life’s contract does not include internal limits that might conflict with the employer’s plan.”
Below is a brief checklist with just some of the key contract language you should review. Learn more by contacting your regional benefits vice president. |
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| A Stop Loss Checklist |
| Specific and Aggregate Exclusions |
Many carriers include specific and aggregate exclusions in their contracts that limit claims. Symetra Life generally follows the eligibility and eligible expense criteria of the employer's benefit plan, which helps eliminate gaps between what the plan will pay for and what we will reimburse. |
| Advance Funding Under Specific |
After the specific deductible has been funded, claims that are adjudicated before the policy period ends are eligible for advance funding (as long as they are submitted within 30 days after the policy period or run-out period end). |
| Reimbursement Requests |
We accept reimbursement requests up to one year after the date written notice is first required. |
| Risk Retention Percentage |
We are a direct writer versus a managing general underwriter, which means we retain 99 percent of our own risk. Some carriers carry zero risk, choosing instead to spread their risk among two or more outside companies. This could complicate and slow your claim. |
| Disclosure at Renewal |
We do not request a new disclosure statement at renewal, which means we will never deny a claim because of an unintentional omission of ongoing or newly diagnosed conditions. |
| Laser at Renewal |
We won’t require employers to “laser” a single, severely ill employee from coverage at renewal, unless specifically requested to do so. |
| Specific Claim Turnaround Time |
Our average turnaround for claims is less than 10 business days. |
| Who Defines What the Reasonable and Customary Amounts Are? |
Your administrator determines what data they will use to define what is reasonable and customary. |
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Stop loss is insured by Symetra Life insurance Co., 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004.
Symetra® and the Symetra Financial logo are registered service marks of Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004.
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