Infusing Risk Management into Benefits Management
218 North Lee Street - Suite 306 - Alexandria, VA - 22314
Phone: 703.778.6520
Client Experiences
With a dedicated focus on medical stop loss and critical illness, Aegis Risk has a deep pool of experience to leverage for its clients - who cover a wide variety of industries with varied coverage concerns.
Scenario One: Our stop loss renewal seems high. Are there cheaper alternatives?
Who
A health care provider with approximately 3,200 employees.
Issues
The incumbent stop loss coverage is provided by the health plan and the renewal is over 50%. Their rates are final.
Recent stop loss claims experience didn't justify the requested rate level.
Further health plan cost reductions were needed, but not at the expense of plan participants.
Solution
Obtained market preferential proposals from four leading, 'A' rated independent carriers.
The selected carrier provided a reduction of $600,000 from the incumbent's renewal premium of approximately $1 million - a 60% reduction.
The significant cost reduction - from the stop loss savings - allowed participant contributions to remain flat for the following year.
Scenario One: Our stop loss renewal seems high. Are there cheaper alternatives?
Who
A health care provider with approximately 3,200 employees.
Issues
The incumbent stop loss coverage is provided by the health plan and the renewal is over 50%. Their rates are final.
Recent stop loss claims experience didn't justify the requested rate level.
Further health plan cost reductions were needed, but not at the expense of plan participants.
Solution
Obtained market preferential proposals from four leading, 'A' rated independent carriers.
The selected carrier provided a reduction of $600,000 from the incumbent's renewal premium of approximately $1 million - a 60% reduction.
The significant cost reduction - from the stop loss savings - allowed participant contributions to remain flat for the following year.
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Scenario Two: We need independent stop loss coverage over multiple claim payors
Who
A domestic subsidiary of a Global Fortune 500 energy company with approximately 3,000 covered employees.
Issues
Introduction of a consumer-driven health plan created a multi-administrator environment. The incumbent PPO managed the existing stop loss. Independent coverage was sought with no dependence on future administrator decisions and changes.
A 15% renewal rate increase - moderate in many circumstances.
Pharmacy expense was an increasing, uncovered component of catastrophic claims.
A $1 million lifetime maximum, lower than the underlying medical plan maximum, created potential exposure to the reimbursement of transplants and other high-dollar claimants.
Solution
Obtained market preferential proposals from four leading, 'A' rated independent carriers. The selected carrier required no rate increase.
Negotiated additional contract enhancements including pharmacy coverage, a $2 million lifetime maximum, and comprehensive run-in claim protection.
Final premium savings and contract enhancements increased coverage value by approximately 27%.
Scenario Two: We need independent stop loss coverage over multiple claim payors
Who
A domestic subsidiary of a Global Fortune 500 energy company with approximately 3,000 covered employees.
Issues
Introduction of a consumer-driven health plan created a multi-administrator environment. The incumbent PPO managed the existing stop loss. Independent coverage was sought with no dependence on future administrator decisions and changes.
A 15% renewal rate increase - moderate in many circumstances.
Pharmacy expense was an increasing, uncovered component of catastrophic claims.
A $1 million lifetime maximum, lower than the underlying medical plan maximum, created potential exposure to the reimbursement of transplants and other high-dollar claimants.
Solution
Obtained market preferential proposals from four leading, 'A' rated independent carriers. The selected carrier required no rate increase.
Negotiated additional contract enhancements including pharmacy coverage, a $2 million lifetime maximum, and comprehensive run-in claim protection.
Final premium savings and contract enhancements increased coverage value by approximately 27%.
______________________________
Scenario Three: Is it time to implement stop loss?
Who
A leading financial services company with approximately 11,000 employees.
Issues
The increased frequency of large claimants, including two above $800,000, caused senior management to request the analysis of stop loss coverage as a 'hedge' against such exposure.
Well managed medical plans, and the resulting single digit increases, caused catastrophic claimants to have a more noticeable budgetary impact.
The review was led by Benefits, but included Risk Management.
A multiple administrator offering required an independent stop loss underwriter.
Solution
Obtained market preferential proposals from four leading, 'A' rated independent carriers.
Provided a multi-year 'risk/reward' projection of transferring the volatility of catastrophic claimants through stop loss premium proposals. Complied with technical requirements set by both Benefits and Risk Management.
Supported a final, objective recommendation to Senior Management to remain uncovered, but initiate an annual review of risk transfer opportunities via stop loss.
Scenario Three: Is it time to implement stop loss?
Who
A leading financial services company with approximately 11,000 employees.
Issues
The increased frequency of large claimants, including two above $800,000, caused senior management to request the analysis of stop loss coverage as a 'hedge' against such exposure.
Well managed medical plans, and the resulting single digit increases, caused catastrophic claimants to have a more noticeable budgetary impact.
The review was led by Benefits, but included Risk Management.
A multiple administrator offering required an independent stop loss underwriter.
Solution
Obtained market preferential proposals from four leading, 'A' rated independent carriers.
Provided a multi-year 'risk/reward' projection of transferring the volatility of catastrophic claimants through stop loss premium proposals. Complied with technical requirements set by both Benefits and Risk Management.
Supported a final, objective recommendation to Senior Management to remain uncovered, but initiate an annual review of risk transfer opportunities via stop loss.