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Medical Stop Loss Insurance

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What is Medical Stop Loss insurance?

Without medical stop loss insurance (also known as excess insurance), one or two catastrophic medical claims could drain the financial reserves of a managed care organization or employer that self-funds its medical plan. Zurich offers Medical Stop Loss Insurance coverage to protect organizations against unexpected surges in the health care costs of their plan participants.

Our stop loss insurance provides a layer of protection that kicks in when medical expenses exceed a certain deductible, on a specific or aggregate basis. Our diverse products, broad coverage limits, specialized underwriting and flexible design help organizations provide the right coverage for their participants while budgeting more predictably — for greater peace of mind.

Why Zurich?

Customized to your plan
Our coverages defer to your benefits plan document to determine eligible claim expenses and enrollment eligibility. This avoids discrepancies, coverage gaps and unpleasant surprises.


Claims service
Zurich’s Claims service earns “Best in Class” scores from our customers.1 We work to minimize both the time and the information required for claims processing.




Budgeting tools
Enhanced renewal options include rate caps and no new “laser” on individuals who are expected to have large claims (i.e., no exclusion of coverage or higher deductible for such individuals).


Solutions

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Employer Medical Stop Loss

Reimburses qualified employers when medical claims exceed a certain dollar amount. Available as specific or aggregate coverage (based on claims of an individual plan participant or the entire group). In addition to medical stop loss plans, we offer employers:

  • Integrated stop loss: An innovative bridge product for employers moving from a fully insured employee health plan to a self-funded one.
  • Incurred stop loss: Reimburses any eligible claim that is incurred within the stop loss policy period, even if the claim is paid outside the stop loss policy period.
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Managed Care Excess

Reimburses a managed care organization (MCO), such as a health maintenance organization (HMO), when large claims exceed a certain dollar amount. Available on a specific and aggregate basis (individual and group).

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Additional services

The following are also available to qualified customers:

  • Broad-spectrum solutions customized for multiple exposures (Medical Malpractice, Property, Casualty, Patient Exposures)
  • Clinical risk management resources and access to preferred cost containment vendors
  • Direct access to underwriting, risk management and claims management

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1. Zurich Closed Claims Net Promoter Score: 83 (January 2017-June 2019). “Best in Class” NPS threshold for insurance industry: 51 (2019). Source: Medallia