Accident and Health Stop Loss Solutions in North America
Managing a self-funded medical benefit plan is not without risk. Catastrophic individual claims or aggregate claims well in excess of expectations can drain the financial reserves of even the best-run plans. As we value feedback from you, our clients, we've developed a number of employer stop loss solutions with your needs in mind. We have a shared understanding of the risks associated with self-funding and are committed to addressing coverage gaps.
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We help you properly manage these risks
Self-funded plans may leave plan sponsors exposed to gaps in coverage. As a leader in employer stop loss solutions, we can offer thought leadership and expertise to improve solutions available to your business. Our risk knowledge helps us to understand this dynamic market so we can work together to develop solutions that adapt to new risks.
We're stop loss experts who take an open-minded approach
While we employ some of the most experienced and respected specialists in the industry, we pride ourselves on listening to you. Your feedback helps us develop flexible stop loss solutions that address challenges of the evolving risk landscape.
Customer-centric focus
With an unparalleled commitment to customer service, we make it easy to do business with us and go above and beyond to ensure our clients' stop loss needs are met. We’re addressing industry inefficiencies and customer pain points, to move the industry forward with tech-driven solutions – rethinking employer stop loss coverage with you in mind.
We're committed to service
Our commitment to excellence in sales and service for our clients extends both internally and externally. We apply fresh market perspectives, knowledge and capital to anticipate and manage the ever-changing employer stop loss industry risk. In doing so, we create smarter, sustainable solutions for our clients and for Swiss Re Corporate Solutions.
Traditional stop loss products
Specific stop loss limits the employer’s eligible medical expenses for each covered individual. Aggregate stop loss limits the employer’s overall annual costs for a self-funded plan. This coverage addresses the accumulation of expenses of all covered individuals on the plan period.
Captive solutions
We collaborate with the industry's leading captive managers to provide stop loss coverage to their captive members. These programs are able to provide all the advantages of a traditional self-funded program with less volatility. They allow smaller employers a way to collectively reinsure their self-funded employee benefit plan and gain control over costs.
Organ Transplant Solution (OTS)
The OTS product allows our clients to carve transplant risk out of their medical stop loss coverage through a pooled transplant stop loss policy. OTS is offered on a stand-alone basis with a 12-month pre-existing condition limitation or underwritten in conjunction with our medical stop loss policy with no pre-existing limitation. We also allow the employer to choose their specific deductible up to $50,000 and whether their coverage will include out of network coverage (subject to state regulation, not available in all states).
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Your service partner
You can expect a dedicated, empowered and passionate team of experienced Claims Professionals who will work with you to keep the claims process simple and straight forward yet tailored to your needs and business.
Your partner for purposeful collaboration
We will proactively communicate with you throughout the claims process to keep you informed on progress. If you have any claims inquiry, our focus will be to resolve it together as soon as possible.
Customer service is much more than simply meeting expectations. It is about trust, relationships, and resolving concerns through transparent and constructive discussions.
Why do business with our Accident & Health team?
Close partnership, financial strength and excellent sales, underwriting and claims services are some of the reasons our customers work with us. Watch our testimonials video below to find out more.
Industry feedback
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Stop loss policies are offered by the carrier Swiss Re Corporate Solutions America Insurance Corporation. Industry representatives are not compensated for their statements but may receive compensation for policies placed with and/or other services provided to Swiss Re Corporate Solutions America Insurance Corporation. Please see updated financial strength rating information at Financial strength ratings | Swiss Re.
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contacts Get in touch
John Fries
Head Accident & Health North America
Richelle Austin
Head New Sales & Business Development
Ronald Nagy
Head Accident & Health Underwriting
Teresa Bair
Head Retention Sales & Account Management
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Links & Downloads
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Forms & Questionnaires
- ACH Claim Payment Authorization
- Aggregate Claims Submission Form
- Employee Eligibility Verification for Stop Loss Claim
- Monthly Aggregate report sample
- Notification Form
- Request for Reimbursement
- SRCS Administrative Services Only Claims Kit
- SRCS Claims Kit
- Third Party Claims Administration Questionnaire
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Disclaimer
Insurance products underwritten by Swiss Re Corporate Solutions America Insurance Corporation. Not all products or coverages may be available in all jurisdictions.