Stop-Loss Insurance · Indiana
Stop-loss insurance helps make self-funding more predictable. It reimburses your health plan when claims run past a set limit, so one catastrophic case can't blow up your budget.
Burt Advisory places and manages stop-loss for Indiana employers. The right contract and continuous oversight are how our flagship client saved $8.9 million over six years without cutting a benefit.
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The Basics
Self-funded employers pay claims directly. Stop-loss is the backstop that caps how much they can pay. It comes in two layers that work together.
Common Mistakes
A cheap stop-loss policy can cost you far more than it saves. These are the four traps we find most often when we audit an existing plan.
The lowest quote usually hides a worse contract with tighter terms, more lasers, or a basis that leaves claims uncovered. Price without contract terms is meaningless.
A 12/12 contract only covers claims incurred and paid in the same year. Run-in and run-out claims at a plan change can fall into a gap nobody priced for.
Carriers can single out high-cost members with a much higher deductible. Without no-new-laser and rate-cap protections negotiated up front, your renewal can jump overnight.
Stop-loss only pays if claims are filed correctly and on time. Miss a notification deadline on a large claim and the carrier can deny reimbursement entirely.
FAQ
Stop-loss insurance is a policy that protects a self-funded employer's health plan from catastrophic claims. The employer pays member medical claims directly, and stop-loss reimburses the plan once claims pass a defined limit. Specific stop-loss caps the cost of any single member; aggregate stop-loss caps the plan's total claims for the year. Together they turn an unpredictable risk into a known, budgetable maximum.
Specific stop-loss covers a single high-cost individual. It reimburses claims on one member above a per-person deductible, protecting against one catastrophic case. Aggregate stop-loss covers the whole group. It reimburses the plan once total claims exceed the policy's aggregate attachment point, protecting against many mid-size claims adding up. Most self-funded plans carry both.
Stop-loss premium varies with group size, demographics, the deductible (specific level) you choose, and the contract terms. A higher specific deductible lowers premium but raises the claims you absorb directly. The right balance depends on your cash flow and risk tolerance, which is exactly what a consultant models before you buy. The cheapest premium is rarely the lowest total cost.
Most employers that self-fund use stop-loss to define exposure to large individual claims and unexpectedly high total claims. Smaller groups often use a level-funded plan, which bundles stop-loss into a fixed monthly payment so the employer gets the protection without managing a separate policy directly.
Lasering is when a stop-loss carrier sets a higher deductible on a specific high-cost member instead of covering them at the group's standard level. It lowers the carrier's risk and your premium, but exposes you to more of that member's claims. We negotiate no-new-laser and rate-cap provisions so your renewal can't be blindsided by surprise lasers.
Yes. Burt Advisory is based in Elkhart, Indiana and places and manages stop-loss for school systems, municipalities, manufacturers, and other Indiana employers. We market multiple carriers, negotiate contract terms and protections, file claims on time, and monitor performance continuously through the United Benefit Advisors network.
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