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Trusted Saskatoon Group Benefits Professionals at Aurora Workplace Solutions Discuss Stop Loss Insurance

Aurora Workplace Solutions are about creating brilliant futures by developing wealth security for businesses and individuals. As experts in the industry, they keep on top of recent news including changes to relevant group benefit plans, retirement savings options, and guidelines and policies. They also keep their eyes open for informative articles we think are of interest to our current and potential clients. Aurora Workplace Solutions are Trusted Saskatoon Group Benefits and Insurance Professionals! 

What is Stop Loss Insurance?

Stop-loss Insurance takes claim off the Employer’s shoulders

When an employee has a health issue requiring expensive treatment, the associated high-cost claims can be significant for their benefits plan sponsor. But it’s impossible to predict when a large claim will arise, so stop-loss insurance, which takes the claim off the employer’s shoulders, is one option to help protect against these unexpected costs.

As a type of insurance policy that sits on top of a benefits plan, stop-loss is available to both fully- and self-insured plan sponsors. When choosing stop-loss insurance, an employer selects a threshold up to which it can reasonably cover claims — ranging from between $10,000 and $100,000 — and any claims beyond that will be covered by the policy.

Stop-loss not a substitute for plan management

The main benefit of stop-loss insurance is its ability to protect the Saskatoon employer from catastrophic claims. For self-insured groups, it primarily acts as a budgeting tool so there aren’t any unexpected hits that could affect accounting.

On the other hand, stop-loss can become costly. While a claim may be mitigated in the first year, premiums can rise in the following years, essentially providing only short-term stabilization. This is especially difficult if the claim is reoccurring, which is the case for most drug claims.

“Stop-loss doesn’t help you avoid cost; it simply helps you prevent an unexpected surge in costs in a given year. It’s not a substitute for plan management.”

Another drawback is that most plans only have a single market for stop-loss insurance, meaning employers can only purchase it from one group, typically their own health insurer, which limits them to that insurer’s quote.

To limit risk, employers can use a pre-existing condition clause for an employee’s first year of employment by setting benefits to a specific limit so they can’t bring in unexpected expenses. Another option is to put a limit on drug reimbursement levels or incorporate provincial drug programs into the benefits plan.

While stop-loss prevents large, unexpected claims from affecting a plan sponsor, it’s important to understand that issues can still arise after a claim is made and employers should be aware of all the available options, so they can make a decision before it’s too late.

Aurora Workplace Solutions design & create custom group benefits plans that meet custom organization goals. Read more about their Group Benefits Plans or contact them today to get started!

'Creating Brilliant Futures'

Aurora Workplace Solutions are Trusted Saskatoon Group Benefits and Insurance Professionals! 

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