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Frequently Asked Stop Loss Questions

• What is Mutual of Omaha's underwriting and laser strategy?
• What are Mutual of Omaha's financial ratings?
• Does Mutual of Omaha reinsure any of its Stop Loss risk?
• How does Mutual of Omaha define a "Paid" claim?
• When will Mutual of Omaha bind a case?
• Will my TPA be audited by Mutual of Omaha?
• What run-in limits does Mutual of Omaha apply to the Specific and Aggregate contract?
• What size groups does Mutual of Omaha prefer to write? Is there a minimum?
• Does Mutual of Omaha take into consideration any other pricing factors when
  evaluating a case?
• What industries are ineligible? What types of groups does Mutual of Omaha prefer?

What is Mutual of Omaha's underwriting and laser strategy?

A: For the Specific, our underwriting focuses on the demographics of the group.
The Aggregate is evaluated on a blending of demographics and claims experience.

In addition to other underwriting options, Mutual of Omaha may laser individuals
when underwriting new business. Upon renewal, we will not laser high-risk claimants unless coverage initially was sold on that basis and the need for the laser continues. Mutual of Omaha will present a variety of renewal options, including lasers, at the employer's request.

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What are Mutual of Omaha's financial ratings?

A: A.M. Best Company – A+ (Superior) – June 2007
Moody's Investors Service – Aa3 (Excellent) – December 2006
Standard & Poor's – AA- (Very Strong) – September 2006

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Does Mutual of Omaha reinsure any of its Stop Loss risk?

A: Mutual of Omaha retains 100% of the decision-making authority on all claims. Mutual of Omaha purchases excess coverage for Specific claims exceeding $650,000.

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How does Mutual of Omaha define a "Paid" claim?

A: We define a "Paid" claim as one that has been processed, provided a draft/check is delivered to the payee within 10 days after the day the claim was processed.

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When will Mutual of Omaha bind a case?

A: Mutual of Omaha will bind a case after receipt and approval of the disclosure statement and application. We will bind a case no earlier than 30 days prior to the effective date.

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Will my TPA be audited by Mutual of Omaha?

A: As a value-added service to our TPAs, we do perform on-site audits.

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What run-in limits does Mutual of Omaha apply to the Specific
and Aggregate contract?

A: Specific run-in is limited to the specific deductible. The run-in limit will not apply to eligible benefits first diagnosed for which services are incurred after the Select Risk Questionnaire has been approved. Spec run-in can be waived after receipt and approval of pended claim reports. There is a 15% of Aggregate run-in attachment point limit.

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What size groups does Mutual of Omaha prefer to write?
Is there a minimum?

A: Our target market is 100+ lives; however, on an exception basis we provide quotes under 100 lives. In most states, the minimum is 50 covered lives.

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Does Mutual of Omaha take into consideration any other pricing factors when evaluating a case?

A: When evaluating a particular risk, we consider PPO penetration, discounts and the medical/case management component.

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What industries are ineligible? What types of groups does
Mutual of Omaha prefer?

A:
Ineligible
EWAs, METs, PEOs, associations, leasing companies, mining, explosives, asbestos products, restaurants, hotels, amusement parks, scrap and waste materials, leather tanning and finishing, and hospitals. These ineligible industries may be considered on an exception basis based on the unique circumstances of the individual group.

Acceptable
Financially stable companies that have been in business for at least three years and have low employee turnover, minimum 50% participation, etc.

Access a complete listing of acceptable, marginal and ineligible industries for Mutual of Omaha TPA Stop Loss quote requests.

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Contact us

For more information about our TPA Stop Loss products, submit a request
or call (402) 351-3932.