Stop loss insurance helps protect employers with self-funded health plans when employees or their dependents experience catastrophic illness or accident, or incur high medical costs for other reasons, such as having a premature baby or needing a heart or kidney transplant. It also protects self-funded employers when their total group medical costs are higher than anticipated.

With a stop loss insurance policy offered through OptumHealth, your company benefits from:

• A history of success—For more than 25 years, we’ve combined our knowledge in the complexities of stop loss, expertise in underwriting, strong protocols in claims management and experience in addressing complex benefit needs to help reduce costs and manage employers’ financial risk.
• Innovation—Finding new ways to help companies like yours manage the risks of self-funded medical plans is what we do. We’re part of the OptumHealth division of Optum, a leading health services company.

How it works
Stop loss insurance provides coverage after an employer with a self-funded health plan has paid a negotiated amount (the deductible) toward employees’ covered medical expenses.

It’s important to note that OptumHealth does not administer your self-funded health plan. We do, however, work closely with your administrator to review and process stop loss claims.

Features
Stop loss insurance can offer you financial peace of mind, with features that include:

• Specific and aggregate coverage—Protect against high individual claims for employees incurring extensive health care costs, and get aggregate coverage to manage claims incurred by your entire group.
• Flexible policy options—Whether you employ 50 employees or 10,000, you can determine the amount of coverage you need – and the amount of risk you’re willing to take – by choosing from different policy options and a wide deductible range.
• Timely reimbursement—If you reach your stop loss deductible limit, your claim will be processed within 10 days of submitting your request, assuming all required information is included in the submittal. Most claims are processed within three days.
• A transition program—Available for companies with 50-200 employees in select locations, the Fully Insured Transition (FIT) program helps you switch from a fully insured program to a self-funded program.

Benefits
You’ll also get additional services that benefit both you and your employees, including:

• Access to our Centers of Excellence network—Stop loss insurance automatically includes access to top, credentialed facilities for transplant, cancer, kidney disease and other catastrophic health conditions. Negotiated discounts with these facilities ensure lower costs for you, better care for your employees.
• Reduced deductible—With our step-down deductible feature, your specific coverage deductible is reduced by 15 percent when a covered participant receives care at a pre-approved Center of Excellence at the contracted rate.
• A medical management team—Our clinical experts consult third-party administrators (TPAs) and case managers, to help manage your medical costs and improve patient outcomes.
• Reduced risk with the Managed Transplant Program—Add this fully insured carve-out option, which covers all transplant-related costs for a standard monthly premium.

OptumHealth Stop Loss products are underwritten by Unimerica Insurance Company, and in California, Unimerica Life Insurance Company.