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• Underwriting
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  • Medical Management Evaluation
  • Renewal Underwriting
• Administration
• Claims
• Large Case
  Management
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• Frequently Asked Questions
• Information
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• TPA/Broker Access

Renewal Underwriting

We apply the highest ethical standards to our renewal underwriting practices. We do not cancel policies because of adverse experience, nor do we decline any individual at renewal as a result of ongoing claims.

Our renewal underwriting philosophy

We use these criteria in renewal adjustment evaluation:

• Medical trend
• Changes in the group's characteristics (e.g., age, enrollment, location, industry, etc.)
• Policy and plan revisions
• Network changes
• The group's experience

We support a "no laser"* renewal philosophy but may present various renewal options for the employer, including lasering, to reduce the fixed cost of known risks.

Information required at renewal

To begin the renewal process, we will send an initial letter to request the following information:

• Current detailed census in an electronic spreadsheet format (active employees, dependents, retirees, COBRA)
• Current and prior year aggregate reports with monthly exposures
• Large-claim information, including the following:
• Current year claims that exceeded, or are expected to exceed, 50% of the specific deductible
• Precertification notices
• Details on serious ongoing/potential claims (ICD-9 or DRG codes)
• Individuals for whom pending claims exceed 50% of the specific deductible
• Current year's PPO penetration and discounts
• Employees/dependents on COBRA

Barriers to renewal

Aside from late submissions, the circumstances under which we decline to reissue a proposal are:

• Plan document has not been reviewed and approved by us
• Group falls below 50 lives (may vary by state due to mandates)
• State law changes with which we are unable to comply
• Specific deductible is less than $15,000
• A change in administrators (not an approved TPA)
• Other circumstances stated in the Stop Loss policy

Contact Us

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