Specialty Health: Medical Stop Loss


Customized Medical Stop Loss Solutions Specifically Designed for Employer's Self-Funded Program

OneBeacon Accident & Health provides access to insurance industry expertise and tailored products, delivered through our dedicated team of sales, underwriting and claims specialists. 

With today’s evolving healthcare market place, employers are continuously looking for ways to help manage the escalating costs of healthcare. Many employers have looked to self-funding their medical plans as a means to manage their benefit spend. Better plan management, potential cash flow improvements and more cost-effective claims management are all important components of self-funding. However, this may not be enough when faced with catastrophic medical claims.

The self-funded employer that selects an administrator based upon its claims management reputation and utilizes the services of a vendor that can offer unsurpassed cost containment, wellness and disease management programs has an expectation of having a return on these investments. These proactive employers who adopt strong incentives to engage their employees expect to bend the trend curve on their claim costs in a favorable direction.

However when it comes to stop loss options, most carriers are pooling the highly engaged employer with a large block of business made up of groups who have not adopted the best programs to contain costs and improve the lives of their members. Proactive employers want to partner with a stop loss insurance provider that understands that “one size doesn’t fit all” and has the expertise to provide the customized support for their self-funded program. OneBeacon is completely committed to these highly engaged employers.


Specialized Protection and Features

  • Defers to Employer's Plan Document to determine eligibility and eligible expenses
  • Customizes medical stop loss policy in recognition of the employer's cost containment efforts
  • Flexible contract terms including an incurred contract option
  • Enhanced coverage options include:
    • Optional rate cap
    • No disclosure statement on renewals
    • Flexible contract terms including an Incurred contract option
    • No “actively at work” requirement
    • Early lock options
    • Specific and aggregate terminal liability options
  • OneBeacon’s Medical Stop Loss provides access to Identity Theft Management Services, including access to a fraud advocate that can assist with medical identity theft, infant and minor identity theft mitigation and other identity compromising situations.

Limits

  • Unlimited specific coverage per member
  • Aggregate limits up to $2,000,000

Eligible Risks

OneBeacon targets employers who select a top-tier administrator and high-quality cost containment vendors to actively manage their self-funded plans.

  • Employer groups in most industries
  • Minimum group size of 100 employees
  • Deductibles from $25,000 to $750,000

A Standard of Superior Claims Support

In the event of a claim, you should expect a high level of performance. We pride ourselves on our quality claims service and the expertise of our claims staff.

Claims management services can include:

  • Advance Funding
  • Optional Monthly Aggregate Accommodation
  • Clean claim turnaround time of 7 days or less

Additional Services: Identity Management for Stop Loss Customers

OneBeacon medical stop loss customers have access to Identity Management Services to assist plan participants who suspect that they are a victim of identity theft. Through a phone call to the designated number, every plan participant who is a victim or suspected victim of identity theft is provided with unlimited access to an assigned fraud specialist who will facilitate the resolution of virtually any identity-related problem, including medical identity theft.

Services include:

  • Medical Identity Theft Assistance – An advocate can work to resolve instances of medical insurance fraud, malicious medical information, denial of benefits due to fraud, and harassment from collection agencies due to medical identity fraud.
  • Catastrophe Personal Document Replacement Assistance – An advocate will replace sensitive personal identity documents, financial records, legal documents and other critical records following a disaster while the victim focuses on rebuilding their homes and lives.
  • Relocation of Residence – An advocate can provide guidance on change-of-address notifications, mail forwarding or bundling, guidance on securing sensitive information during the move, replacement of lost documents, and an Identity Wellness Checkup after the move.
  • Identity Travel Response – An advocate will work with governmental agencies to help the traveler get lost documents reissued on an expedited basis, work with airlines and hotels to replace lost tickets, and assist in getting credit cards protected and replaced or receiving emergency cash from home without identity documents.
  • Surviving Spouse Response – An advocate will assist the surviving spouse in reviewing the deceased’s credit and financial files, looking for benefits associated with credit cards, making the appropriate notifications, assisting with obtaining important documents such as military records, birth certificates and death certificates, and resolving any fraud issues uncovered.
  • Infant and Minor Identity Risk Mitigation – An advocate works to review your child’s information, resolve any instances of fraud, and suppress your child’s credit files, when available, until the age of majority.
  • Deployed Military Personnel Identity Risk Mitigation – An advocate can work with family members to review credit and personal information, add a protective Active Duty Military Alert on credit files, and remove names from pre-approved credit offers.
  • Marriage and Divorce Identity Risk Mitigation – An advocate can provide tips on securing credit and financial information while planning a ceremony, assistance with marriage license requirements, documentation for name-change requirements, considerations for life partners, and an Identity Wellness Checkup before marriage or after a divorce.

Other Specialty Health Coverages

Provider Excess

Target: Healthcare providers who are financially responsible for the cost of medical services under capitated contracts or other risk-based contracts.

More Info

HMO Reinsurance

Target: Managed care organizations that are financially responsible for the costs of medical services.

More Info


phoneContact Us:

OneBeacon Accident and Health
44 Whippany Road
Morristown, NJ 07960

Christy Vago
cvago@onebeacon.com
781.332.7924

Request for Information:

Click on the link to access the request overview for information for each product area. These will provide details of what is needed for a submission to be considered. 

Medical Stop Loss
Provider Excess
HMO Reinsurance