How Stop Loss Adds Protection And Value To Health Insurance Plans

What Is Stop Loss Insurance?

Stop loss insurance protects against catastrophic or unpredictable losses. Employers often buy stop loss insurance when they decide to self-fund their employee benefit plans, but do not want to assume complete liability for any losses arising from their health plan selection.

There are two types of stop loss insurance:

1. Specific stop loss protects an employer from a high-cost claim for any one individual.
2. Aggregate stop loss offers protection when an entire group’s healthcare claims exceed expectations.

You don’t need to pick between these two types of stop loss insurance. You can purchase both types for maximum protection.

Who Should Have Stop Loss?

If you are an employer foregoing traditional health insurance or benefit plans and instead self-insuring, you should consider adding stop loss insurance. While self-insuring can offer more flexibility or cost savings, it can also dramatically increase your risk. Stop loss delivers essential financial protection and heightened stability for your business, establishing a cap on the amount you, as the employer, will be responsible for paying.

Why Is Stop Loss Becoming More Important?

Many factors can affect the need to limit your financial risk, especially in healthcare:

• Inflation is one of the most pressing economic concerns, impacting almost every facet of the U.S. economy, from worker wages to increases in the price of gasoline, food, and healthcare.
• Emerging gene therapies hold immense promise for treating challenging rare conditions, but they also come with significant cost-related risks. 
• 90% of adults believe there is a mental health crisis in the U.S. today. Increased outpatient visits for mental health and substance misuse can impact employers through not just claim costs, but also lost productivity and reduced employee engagement.
• Lingering disruption and care delays caused by the COVID-19 pandemic have led to delayed cancer diagnoses and increased treatment costs for both cancer and chronic conditions.

Although these are the factors currently at play, it's essential to recognize that circumstances evolve, and new risk elements may swiftly escalate other health costs. It’s important to ensure your organization can get the right coverage to stay protected, while still offering your employees high-quality health coverage. 

How Does Anthem Stop Loss Provide Additional Benefits?

While many carriers restrict stop loss coverage to medical claims, Anthem goes beyond by including pharmacy coverage and offering the option to add vision and dental benefits. Through personalized guidance, you can receive assistance in tailoring a policy that aligns with your specific needs, budget, and risk tolerance. The focus remains on cost control, streamlining administrative tasks, and enhancing employee outcomes.

With dedicated resources such as underwriting, claims support, and customer service, you’ll be provided with a deep understanding of the markets Anthem serves through extensive historical healthcare data. This allows for proactive and innovative methods to control health insurance costs, leveraging collaborative expertise for your benefit.

Combining Anthem  stop loss protection with an Anthem medical plan can lead to even greater benefits. This can streamline your billing and administration, improve cash flow, and protect your business from high-claim costs.

If you’re looking to protect your business from the unexpected and have increased control over costs, stop loss coverage with Anthem can give you the confidence of feeling secure. You don’t only get a stop loss policy, you:

• Get a unique combination of local experience and national expertise that only Anthem can deliver.
• Stay protected from large claims, while finding greater value in your health insurance plan and delivering better outcomes for your employees.
• Receive proactive solutions to your specific challenges, reducing your costs every step of the way.

Our solutions can complement your approach to offering health insurance and employee health benefits.