As more and more middle-market employers turn to self-funding their benefits as part of their cost-containment strategy, some stop-loss insurers are lending a helping hand with incentives to adopt medical management programs.
Many stop-loss underwriters providing excess coverage will consider effective wellness and disease management programs in calculating premiums for specific stop-loss coverage, which pays claims of an individual plan member that pierce a certain deductible threshold, or aggregate stop-loss coverage, which pays when total actual claims exceed 125% of total expected claims
Ken Olson, division president of The Horton Group Inc., a middle-market insurance broker based in Orland Park, Ill., said he often has been able to persuade stop-loss underwriters to shave up to 5% off of a specific stop-loss premium “if I can tell a good story that demonstrates the impact of wellness and disease management on a particular employer's claims experience.”
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