Stop Loss Insurance

Features & Options

Stop Loss Programs That Guard Financial Health

Whether covering groups of 100 or 2,000, HM Stop Loss enables self-funded employers to protect their assets from unexpected large or catastrophic claims, helping to protect financial wellbeing as health care costs continue to rise in a changing market. Using a wide range of deductibles and contract periods, we structure custom plans to help satisfy specialized needs and help mitigate claim risks.

Some HM Stop Loss product features include:
  •  Specific and Aggregate coverage
  • Contract periods of 12/12, 12/15, 12/18, 12/24, 15/12, 18/12, 24/12
  • Unlimited Specific coverage maximums to comply with health care reform
  • Aggregate coverage maximum up to $2,000,000 per policy period
  • Specific deductibles from $25,000 to $2,000,000
  • No new lasers or increase to existing lasers at renewal
  • No signed disclosure form required at renewal

Coverage Choices for Customized Plans

HM offers a variety of options that allow you to select the right coverage for your clients’ financial situations.

Specific and Aggregate Terminal Liability – Employers converting to fully insured coverage can extend Specific and/or Aggregate Stop Loss insurance for an additional three or six months following termination of the policy to help reduce the risk of uncovered claims when a Stop Loss policy ends.

Bridge Renewal – For employers with a 12/15 or 12/18 Specific Stop Loss contract seeking protection from claims paid outside of their run-out period, this coverage extends the paid period to 24 months for clients renewing a Specific contract.
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Monthly Aggregate Accommodation – When year-to-date Aggregate claims are higher than expected, we provide the opportunity to settle claims on an interim monthly basis. This option allows for partial payments to the Aggregate coverage during the policy year versus waiting until the end of the policy year for claims reimbursement, thus helping to improve the client’s cash flow.
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Advance Funding – In situations where extremely high-dollar claims occur, Advance Funding can assist groups by advancing funds for a Specific claim, allowing for coordinated reimbursement. This may help to alleviate a cash flow issue. The rider can be selected at the point of sale or renewal.
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Aggregating Specific – Clients can reduce their Stop Loss premium by assuming more claim liability. With the Aggregating Specific feature, the client agrees to accept an amount of additional risk in exchange for the financial advantage of paying lower Stop Loss premiums. This feature is solely a financial arrangement and does not impact employee medical benefits. The Aggregating Specific feature is recommended for clients financially suited to accept additional risk.
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Disclaimer Coverage is underwritten by HM Life Insurance Company, Pittsburgh, PA, in all states except New York under policy form series HL601 or HMP-SL (11/16) or similar. In New York, coverage is underwritten by HM Life Insurance Company of New York, New York, NY, under policy form series HL601 or HMP-SL (11/16) or similar. In Pennsylvania, coverage may be underwritten by Highmark Casualty Insurance Company under policy form series HC601 or HMP-SL (11/16) or similar. The coverage requested may not be available in all states and is subject to individual state approval.