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Blue @ Work

What you need to know about stop-loss coverage

Protect your workplace from extreme loss with stop-loss coverage.

Self-funded health insurance benefits — whether you’re a smaller, family-owned business or large corporation — don’t come without risk. Your employees may be relatively healthy, but a sudden medical diagnosis could lead to higher-than-expected medical costs. That’s when stop-loss coverage can help.

How stop-loss coverage works

Stop-loss coverage isn’t medical coverage — it’s a financial and risk management tool for your business that caps what you pay toward your employees’ medical expenses at an agreed amount. Any services covered by your medical plan above that threshold are typically covered by the policy, unless the incurred date and paid date of claims fall outside a stop-loss period.

Stop-loss coverage helps protect your business from major, unexpected medical costs that could, at best, put a large dent in your cash flow — and, at worst, affect major business operations or put some companies out of business. While the coverage reimburses employers when costs rise above the set limit, as a self-funded plan sponsor you’re typically still responsible for initially paying medical expenses in full.

Two different policy options

There are two different policy options for stop-loss coverage: Individual and Aggregate. Use this graphic to determine which coverage is best for your business.

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Individual stop-loss coverage. Limits financial liability for each individual member. Can be carried with or without aggregate coverage.

Aggregate stop-loss coverage. Limits financial liability for your total amount of claims expense as a whole. Cannot be carried without individual coverage.

More stability with stop-loss

If you have a stop-loss policy with Wellmark Blue Cross and Blue Shield, you have several different billing options to suit your specific financial situation. You can choose to have a monthly statement with stop-loss credits settled at the end of every month, or choose to withdraw either a set amount or an actual claims amount every week.

A weekly billing method offers stability and consistency in your stop-loss coverage. For example, if you have an individual member claim of $250,000, and an individual stop-loss amount of $100,000 on a typical stop-loss plan, you’d pay the $250,000 up-front and get $150,000 reimbursed at the end of the month. Wellmark’s newest billing option debits weekly claims up to your stop-loss amount, which is when your policy handles the rest — and you don’t have to wait to be reimbursed.

Have questions or want to learn more about Wellmark’s stop-loss policies? Talk to your Wellmark representative or email us at blueatwork@wellmark.com Send Email.

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