Frequently Asked Questions

Please provide the following ratings for the carrier over the past 3 years.  If there are any downward changes please explain.

AM Best rating:

Gerber: A

Companion: A+    

United States Fire: A  

Describe the carrier’s involvement in the stop-loss business from the time they first began writing stop-loss.  Please explain any years in which they ceased writing or renewing the business.

We have been writing stop-loss with Gerber since 1990, Companion since 2003, and United States Fire since 2006.

Describe how your stop-loss business is sold and administered. 

Eighty percent of our business is sold and administered through TPAs and the remainder is broker driven. 

Please list any states in which the carriers are not writing stop-loss business.

 Hawaii

 Name, address and phone.

Montgomery Management

2 Valley Square, Suite 110

512 Township Line Road

Blue Bell, PA  19422   

Phone                      (215) 793-0313  

Toll Free                  (800) 883-1500       

Fax                         (215) 793-0535

What duties does the MGU perform on behalf of the carriers (e.g. claims payment, premium collection, underwriting, etc.)?  What duties do the carriers reserve for themselves?     

Montgomery Management performs all services on behalf of its carriers.

Underwriting Questions

Please provide a checklist or data form showing the basic information you will expect to receive to be able to provide a proposal.

1. Census.

2. Plan description including managed care features.

3. Profile of the employer group to be quoted.

4. Claim experience for at least two years if the group is over 130 lives.

5. Details of any large claimants (at 50% of specific and/or with a trigger diagnosis).

If the information needed to renew a case differs, please note what information is needed at renewal.

For renewals or cases in force with the qualifying TPA, we expect all of the above plus aggregate reports that include pending claims.

 How long does it take for you to issue a proposal once you have all necessary data?

Generally turn around time will average four to five days.

Please provide an expected time line for renewal rating (i.e. when do you require renewal data, how much prior to the anniversary will rates be given, etc.). 

Request for renewal data is solicited in a reminder letter between 60-75 days prior to the renewal date.  Most renewals are completed 30-45 days in advance of the renewal date. Renewals require updated claim information up to 30 days prior to the renewal date.

For new cases, describe how known ongoing large claims are handled. 

Montgomery Management prefers to offer multiple options in such cases.  The group will have the alternatives of 1) specific deductible laser(s), 2) aggregating specific deductibles or 3) increased premiums.

Discuss your renewal philosophy.  Be specific as it relates to known ongoing large claims, lasering out, and rating up.

Our specific rate renewal increase is determined by the case’s current and prior loss ratios.  Cases with favorable loss ratios will receive moderate increases.  Consideration is given to cases having less than favorable loss ratios where the losses are due to large claimants who will not be ongoing concerns in the future contract period.  We try not to laser at renewal if possible.  We will provide an option that would include the lasered amount in the premium.

Do you require life insurance coverage?  If yes, what is the minimum certificate amount?

 No, we do not require Life Insurance.

Are Taft-Hartley, MEWA, Associations, or other multiple employer groups eligible?

We generally do not quote on multiple employer plans.  However, if there are good controls and credible experience, we will assess the groups on a case by case basis.

Do you underwrite any other coverages other than stop-loss?  If yes, what coverages?

 We also offer Life, AD&D, Dental, STD, LTD, and dependent life.

What is your minimum number of lives, minimum attachment point and specific deductible?

Minimum lives are 35

Minimum specific is $15,000.00

Minimum attachment is 125%

Describe your binding authority and at what point is coverage bound?

We have full binding authority.  Coverage is bound when all proposal requirements are satisfied and approved, including disclosure.

General

Please provide a list of names, titles and phone numbers for key contract persons for claims, underwriting, sales, etc.

Please see our contact us list

Do you provide sales bonuses, profit bonuses or other items or services of value to your producers?  If yes, please explain.

We do offer bonuses/overrides to our TPAs/brokers who generate and maintain significant blocks of business with MMC. 

 Please provide a copy of your commission schedule.

Commissions are built in to each quote on a case by case basis.  Not including overrides our maximum is 15%.

Do you send forms 5500 Schedule A for stop-loss contracts you issue?

We provide “schedule A” information upon request.

Do you provide quotes through more than one source of business? Explain.

We do offer multiple quotes.  However, we will not issue duplicates once the incumbent TPA has submitted an RFP. 

Will you allow a case to transfer from one Third Party Administrator to another? Explain.  

 We have allowed transfers of TPAs with a letter of intent from the employer group.

Claims

What information do you require to process specific and aggregate stop-loss claims?

Aggregate claims under $30,000 receive a desktop audit; claims above $30,000 are audited on site at the TPA’s location. 

How long does it typically take for you to pay both specific and aggregate claims?

Fifteen working days.

Describe your claim auditing procedures

Claims are reviewed for eligibility, funding, plan benefits, and stop loss requirements.

If hospital audits are performed, do you pay for them?  Under what circumstances do you pay the cost?

Yes, if the audit is deemed necessary by the TPA or MMC.

 How do you handle very large claims where the group cannot fund the entire amount? (i.e. will you release your payments before the plan pays, concurrently, other?)

 All claims must be funded to the stop-loss level.

Do you participate in special claim administration costs such as subrogation expenses?  Defense of lawsuits? Other? If so, under what circumstances?

Yes

If you purchase reinsurance protection, does the reinsurer need to review all claims before they are paid, or are your decisions binding on the reinsurance?

We have full authority on claims.

Do you require that large claim management services be used?  Under what circumstances?  Do you pay for such services?

Yes.  Large case management is mandatory on all of our groups.  The expense is covered under our contracts.