Who – and What – You’re Working with Really Matters

In an industry where multimillion-dollar claims are common, securing financial risk protection you can count on is essential. That means working with the right Stop Loss carrier really matters. It also means that the data the carrier works with when underwriting the coverage really matters too.

Complete, detailed data helps the Stop Loss carrier properly assess risk and provide coverage that can best meet each group’s needs. There are fewer unknowns with complete, detailed data, and that gives the carrier the ability to create a balanced offering with pricing that reflects the actual risk involved. In a challenging market, some carriers may offer early locks on business with many unknowns, but in the end, that approach creates more volatility for the group and the Stop Loss carrier, threatening the financial stability both need for success.  

At HM Insurance Group (HM), we want our underwriters to assess each case using complete, detailed data. Not only does this enable us to better meet deadlines on quality RFP submissions, it also gives us the information we need to support sound risk selection and appropriate pricing. It helps us understand the employer’s needs, so the coverage can strongly align. When data is incomplete, it can lead to delays, less competitive pricing, and additional requests that become cumbersome to everyone involved.

Simply put, complete, detailed data leads to a cleaner, smoother underwriting process. If you want to help ensure you’re providing everything necessary for a timely and accurate Stop Loss quote, key claims information includes:

•    Claims experience for the current policy year and two prior years
•    Details using contract/policy timeframes
•    A minimum of six months of current policy year data (seven months for renewals) for an illustrative quote, with data including:
•    Large Claims Report with diagnosis, claimant name/identifier, and paid amount (50% reporting)
•    Aggregate Claims (monthly paid claims and monthly enrollment)

o   Claims broken into categories (Medical, Rx, Dental), allowing us to confirm what claims should be included in our calculations
o   Verification if claims are on a net or gross basis, helping us to determine if claims over the Specific deductible need to be taken out or if they have already been accounted for
o   Enrollment on a monthly basis, so we can see any increase or decrease in counts and if we need to adjust our calculators for them
        -        Use Subscriber count, not member count
        -        Include monthly paid claims
o   Monthly claims for any run-out involved

•    Specified Monthly Subscriber or Contracts for Enrollment (not members)
•    Copy of a Transplant Policy, if carved-out, for firm quotes
•    Rx Claims information from ground-up total for each claimant (specifying if it is within Medical Reporting or separate Rx Reporting) including:

o   Specific: Paid claim summary and detail with drug name/dosage, claimant ID/name (matching to medical)
o   Aggregate: Monthly experience

•    Claims for the time period on any run-out contracts

As a leading national Stop Loss carrier, we work to ensure that we are providing our clients with the right coverage at the right price. Having complete, detailed data fuels this capability, giving us a clearer view of the risk involved and enabling us to build more stability into the employer’s Stop Loss protection. Even as the industry faces a continued trend in rising medical and pharmaceutical costs, clients who choose HM can feel confident that their claims will be paid because we do the right work upfront – and that makes all the difference in the end.