Broker Products

• Overview
• Underwriting
  • Submitting New Business
  • PPO Evaluation
  • Medical Management Evaluation
  • Renewal Underwriting
• Administration
• Claims
• Large Case
  Management
• Forms
• Frequently Asked Questions
• Information
  Request Form
• TPA/Broker Access

Submitting New Business

We issue Stop Loss proposals only to our approved TPAs. Licensed, appointed TPAs may submit new business to our underwriters by mail, fax or e-mail.

To help us evaluate risk appropriately, bid requests must contain employer, plan and general information, plus complete data on large claims.

Employer information

• Company name
• Company city, state, ZIP
• Nature of business
• Census in an electronic spreadsheet format

Plan information

• Schedule of benefits
• PPO networks and related discounts
• Name of managed care vendor(s) (UR/CM, etc.)
• Current and renewal rates
• Current and requested specific deductible
• Current and requested loss claim basis
• Benefits to be covered under aggregate
• Current and previous carriers
• Employer contribution

General information

• An existing employer/employee relationship
• Single employers only – no association groups, METs, MEWAs or employer leasing firms
• In-force group medical coverage, preferably self-funded
• No more than three insurance carriers in the last five years
• Participation level of 100% when employer pays 100% of premium
• Minimum participation level of 75% of those electing coverage when the employee pays a portion of the premium
• Minimum 50% participation of total employer group
• Steady or increasing plan enrollment
• Financially stable
• Low percentage of seasonal workers eligible for coverage
• Low employee turnover

Plan Eligibility Provisions

• TPA name, contact person, phone and fax numbers, e-mail address
• Current and requested commission level
• Requested effective date
• Broker of record (name, address, phone number, state licensed in)

Large Claim information

To evaluate claim risk associated with large claims, complete information is important, including:

• Large claims for the most recent 24 months
• Details on serious ongoing/potential claims (ICD-9 or DRG codes)
• Monthly claims and exposures for the most recent 24 months
• Details on employees/dependents not currently working or unable to work
• Employees/dependents on COBRA

Disclosure information is received 30 days or less prior to the effective date. This may be extended to 45 - 60 days based on group specific circumstances.

Quote Request

Our goal is to have 100% of our proposals completed within 10 business days of receipt.

If the underwriter determines that there is an opportunity to provide a competitive quote, a proposal is issued. The proposal contains the following:

• Premium rates
• Aggregate deductible factors
• Schedule of benefits
• Bid contingencies
• Assumptions
• Select risk questionnaire

Contact Us

For more information about our underwriting or TPA Stop Loss products, submit a request.