STOP LOSS INSURANCE

Stop loss insurance helps protect employers with self-funded health plans when their group medical costs are higher than anticipated or employees or their dependents experience catastrophic illness or accident.

Why choose Optum stop loss insurance?

• We have a history of success. For more than 25 years, we’ve combined our knowledge in the complexities of stop loss, expertise in underwriting, strong protocols in claims management and experience in addressing complex benefit needs to help reduce costs and manage employers’ financial risk.
• We’re trusted by companies like yours. Optum is backed by the strength and stability of UnitedHealth Group and its highly rated insurance companies.
• We’re innovative. We adapt to meet the changing needs of the marketplace and find better ways to help you manage health care costs.

Features

Stop loss insurance can offer you financial peace of mind, with features that include:

• Specific and aggregate coverage. Specific coverage protects against high individual claims when employees incur extensive health care costs, and aggregate coverage manages claims incurred by your entire group.
• Flexible policy options. Whether you employ 50 employees or 10,000, you can determine the amount of coverage you need — and the amount of risk you’re willing to take — by choosing from different policy options and a wide range of deductibles.
• Timely reimbursement. If you reach your stop loss deductible limit, your claim will be reviewed within 10 days of submitting your request.
• A transition program. Available for companies with 50-200 employees, the Fully Insured Transition (FIT) program helps you switch from a fully insured program to a self-funded program.

Benefits

You’ll also get additional services that benefit both you and your employees, including:

• Access to Optum Care Solutions’ Centers of Excellence network. Our stop loss program includes access to top, credentialed facilities for transplant, cancer, kidney disease and other catastrophic health conditions. Negotiated discounts with these facilities ensure lower costs for you, better care for your employees.
• Reduced deductible. With our step-down deductible feature, your specific deductible is reduced by 15 percent when a covered participant receives care at a pre-approved Center of Excellence at the contracted rate.
• A medical management team. Our clinical experts consult with our underwriting and claims teams, as well as third-party administrators (TPAs) and case managers, to help manage your medical costs and improve patient outcomes.
• Reduced risk with the Managed Transplant Program. Add this fully insured carve-out option, which covers all transplant-related costs for a standard monthly premium.

Add Optum stop loss insurance to your self-funded plan

To find a Stop Loss representative in your area click here.

Stop Loss products are underwritten by Unimerica Insurance Company, UnitedHealthcare Insurance Company and Unimerica Life Insurance Company of New York, and in California, Unimerica Life Insurance Company.