Underwriting | Parameters

Requests for stop loss proposals should include the following:

A census indicating date of birth, gender, coverage tier (i.e. single/family) and zip code.
The group’s location and nature of business (SIC code).
Current schedule of benefits; proposed benefits (if applicable).
Diagnosis and prognosis for all individuals who have reached 50% of the specific deductible.
Disclosure of claimants with trigger diagnosis.
Current funding arrangement ( i.e. self-funded, fully insured).
For groups with over 130 lives, a minimum of 18 months of mature claims experience and enrollment is required in order to provide an aggregate quote. A manual aggregate proposal will be issued for groups under 130 lives.
Current rates and factors if available.

Any variance from these guidelines may be evaluated on a facultative basis at the underwriter’s discretion.

Parameters

Minimum Specific deductible: $15,000
Minimum number of lives: 25
Minimum participation of eligible employees: 70%
Participants over 55 year old may not exceed 25% of the group.
No aggregate only coverage.
No sealed bid quotation.
Group with over 130 lives that have 30% or more HMO participation are excluded.
Groups with 3 carriers in the past three years are excluded.
Maximum of 10% non-Medicare primary retirees.
Domestic reimbursement for hospital groups may not exceed 70% of billed charges.

Ineligible Industries

Restricted Industries