Aggregate Stop-Loss

SLPC 24040 10/17 (exp. 10/19)

Aggregate Stop-Loss insurance provides financial protection when the total of all claims under the Specific deductible is higher than expected.

How does it work?

At the end of the policy period, we reimburse the employer for all eligible claims costs above the pre-determined Aggregate deductible level.

What's covered?

Typically, employers choose a Sun Life policy that covers medical and prescription drug expenses. If the employer wants to add more coverage, we can also provide reimbursement for dental care, short-term disability, and vision care expenses. We offer a wide range of claims bases so that coverage can match employer needs.

Optional features

  • Wide range of claim bases, with run-in, run-out, and paid options—choose the claims approach that best fits the employer's self-funded strategy
  • Terminal Liability—extend coverage for an additional three months following the termination of the stop-loss policy
  • Monthly Aggregate Accommodation—receive monthly reimbursements during the policy year rather than one lump payment at end of the year if the claim costs for the entire group exceed a predetermined amount

Cost-containment resources

We deliver opportunities for employers to save.

  • Sun Life Nurse Consultants may identify opportunities that can improve patient outcomes and lower claims costs, before and after a stop-loss claim occurs.
  • SunResources® specialty-vendors access program provides opportunities for significant savings.
  • SunExcel® transplant-vendors access program provides opportunities for improved patient outcomes and significant claims savings.
  • SunEliteSM medical plan document review service provides an analysis of cost-containment, federal law compliance (including Affordable Care Act compliance), and discretionary authority language.

Advantages for employers

  • Experience—we are a leading carrier with over 30 years of experience as a direct writer of stop-loss insurance
  • Flexible deductible levels
  • Wide range of claim bases—with run-in, run-out, and paid options
  • Specialized claims services—direct deposit, claims decisions in an average of 10 days or less, and more
  • Money-saving resources—on-staff clinical experts and cost-containment programs

Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 07-SL. In New York, group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Windsor, CT) under Policy Form Series 07-NYSL REV 7-12. Product offerings may not be available in all states and may vary depending on state laws and regulations.