Medical Stop Loss

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Medical Stop Loss

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Highlights

Minimum group size of 50 lives
PPO, UR and large-case management program credits and referrals
Consultative pricing including credits for PPO, UR, large-case management programs, and alternative plan design solutions including Reference Based Pricing
Rate Stabilization policy endorsement (no New Laser with rate cap)
Market-competitive excess loss contract
Specific advance and expedited reimbursement options for ASO and TPA managed plans

Specific coverage

Customized stop loss is provided to address the employer's exposure to high-cost medical expenses on a covered individual.

Specific deductibles range from $25,000 to $2 million
Unlimited lifetime maximums
Contract basis: Gap-less, 12/12, 12/15, 12/18, 12/24, 15/12, 18/12, 24/12 and PAID
Coverage options available: medical, prescription drug

Aggregate coverage

Aggregate stop loss coverage limits the employer's overall annual cost for a self-funded plan. This coverage addresses the accumulation of expenses on all individuals (as opposed to high expenses for particular individuals).

Competitive attachment points
Per-policy period maximum available: $1 to $5 million
Contract basis: Gap-less, 12/12, 12/15, 12/18, 12/24, 15/12, 18/12, 24/12 and PAID
Coverage options available: medical, prescription drug, dental, vision and WDI

Claims, Risk Management, Cost Containment

QBE’s industry leading Claims, Risk Management, and Cost Containment teams are dedicated to helping our clients minimize the financial impact of claims, while preserving the quality of care for members. Our team of accomplished nurses continuously review and monitor potential and ongoing claims to identify cost savings opportunities. Once an opportunity for savings is identified, we collaborate with our clients to recommend cost containment solutions to preserve our client's plan assets.