Specific Stop-Loss

SLPC 24042 10/17 (exp. 10/19)

Specific Stop-Loss insurance provides financial protection for self-insured employers from large claims that occur for any one covered individual.

How does it work?

When an employee's or dependent's covered medical claims exceed a pre-determined limit (the deductible level), Sun Life will reimburse the employer for the amount of covered claims that exceeds the limit.

What's covered?

Typically, the stop-loss policy reimburses medical expenses, in excess of the deductible, that are covered by the employer's self-funded medical plan.

Optional features

  • Wide range of claims bases with run-in, run-out, paid, and gapless options—choose the claims approach that best fits the employer's self-funded strategy
  • No New Lasers at Renewal option with Automatic Rate Cap—avoid higher risk exposure due to individual catastrophic claims in the prior policy year
  • Aggregating Specific deductible—choose to manage more risk in order to reduce stop-loss premium costs
  • Terminal Liability option—extend coverage for an additional three months following the termination of the employer's stop-loss policy
  • Predictable renewals—employers experience more consistent renewal costs over time through Sun Life’s pooled risk approach

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 savings.

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, paid, and gapless options
  • Specialized claims services —direct deposit, claims decisions in an average of 10 days or less, and more
  • Money-saving resources—on-staff clinical professionals 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.