Archived Insight | May 12, 2021

Medical Stop-Loss Insurance Checklist

Segal works with hundreds of group medical plans to help them get the medical stop-loss insurance that best meets their needs.

We compiled this stop-loss insurance checklist you can use to make sure you’re getting the right coverage for your plan.

Get the Checklist

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Highlights from the checklist

The checklist can assist you with:

  • Determining the adequacy of your current stop-loss coverage by reviewing your actual claims data
  • Setting up monthly high-cost claim reporting
  • Implementing third-party audit protocols for any known inpatient hospital or drug claim with $100,000 or more in submitted claims pending
  • Obtaining current plan coverage documents and amendments annually
  • Requesting bids every two to three years to make sure you’re getting the best possible deal on your stop-loss coverage

There are many other important points covered in the full checklist. 

Questions about medical stop-loss insurance?

To discuss the adequacy and competitiveness of your plan’s medical stop-loss insurance, get in touch. 

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ACA Dollar Amounts and Percentages

We’ve added the 2025 percentage for the test applied by the Exchange or a Marketplace when determining if offered coverage is affordable.

This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.