SLPC 24042 2/20 (exp. 2/22)
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 specific deductible level), Sun Life will reimburse the employer for the amount of covered claims that exceeds that limit.
Typically, the stop-loss policy reimburses medical expenses, in excess of the deductible, that are covered by the employer's self-funded medical plan.
- 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
We deliver opportunities for employers to save.
- Sun Life Nurse Consultants who review claims for opportunities that can improve patient outcomes and lower claims costs, before and after a Stop-Loss claim occurs.
- SunExcel® specialty-vendors access program provides opportunities for significant 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.
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 REV 7-12. In New York, group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) 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.