Two workers on a job site wearing helmets look at blueprints while two other workers in helmets walk across nearby rafters.

Thursday, August 10, 2017

The Contract Is the Cornerstone

By Greg Wilden

Having been around the Stop Loss world for 30 years, I know that without a solid foundation of expectations and the type of commitment that HM has with our producers and our mutual clients, good partnerships can fall apart. And in the Stop Loss realm, the groundwork starts with a well-constructed contract.

For sure, not all contracts are alike. The fallout we have seen employers and producers face with poorly designed contracts is unacceptable at HM. We consistently revisit our contract to make we are not leaving gaps to our policyholders, which would, in turn, put our producers at risk as well. We’ve built our business on our contract’s clarity, flexibility and choice.

As we continue to see the frequency and dollar amount of shock claims escalating, we know our contract is the foundation to providing the right protection to our policyholders. It also provides a comfort level to our producers by demonstrating that HM honors our commitments. Here are the four key ways an HM contract works to protect your clients and your reputation:

Uses Language Clients Understand – Our contract is clearly written and designed to be easy to follow. It effectively presents the details of the program so that clients can understand the policy easily. We spell out our financial commitment, and the care we take in addressing each detail reflects the value we place on building strong relationships through appropriate communication.

Mirrors the Underlying Plan – Our policy provisions allow the Stop Loss coverage to mirror the underlying health plan. This helps to eliminate gaps in coverage and protects plan assets by limiting the group’s liability. (What this really means is that we are looking out for each group’s best interest by helping to ensure they aren’t responsible for a multi-million dollar expense caused by a gap in coverage.) Self-funded employers need to understand that if definitions, provisions and/or eligibility rules differ between their underlying plan and their Stop Loss contract, it can result in claim reductions or denials that can cost them more – and we think that is a bad way to do business, so we work to prevent that from the start.

Aligns with Legislative Requirements – Whether it’s regarding the regulations brought about by the Affordable Care Act or potential legislation of the future, we stay on top of the mandates and governmental requirements that impact our industry and our coverage. We are engaged and aware, and our can count on our efforts to ensure that all provisions are followed and detailed.

Offers Administrative Ease and Choices –We offer clients features and options designed to make it easier to administer their plans and do business with us. Our streamlined contract has limited exclusions and helps to ease clients away from the fear of “gotchas.” This is a policy they can trust. It contains riders that easily depict the options available to meet the needs of their individual circumstances.

When we are partnering with producers and protecting our mutual clients, we know that the quality of our contract reflects the core of our commitment. It details obligations and sets expectations. And since our clients count on us to guard their financial health in a challenging health care environment, we attentively work to ensure that our contract – our word – serves as the mainstay for protection.

Why HM

A strong, experienced carrier, HM responds to market changes and works with clients to ensure their coverage needs are met through expert risk assessment and exceptional delivery of benefits.