Employer Medical Stop Loss
Providing healthcare benefits has been a major tool by employers to attract and keep talent within their workforce. This tool however, can be a very expensive and complex one depending on the structures available to the employers. One of these structures is self-insurance, in which the employer assumes the financial risk for providing healthcare benefits to its employees. Employers may have many reasons for opting to self-insure, which could include amongst other reasons, improved cash flow, custom-designed health plans, and greater control and tax savings. To help stabilize results, employers can opt to purchase stop loss insurance above a set deductible. Physicians Insurance has been providing stop loss insurance to self-funded employers since 2002. Whether your stop loss needs are local in the Pacific Northwest or elsewhere, Physicians Insurance will partner with you to customize a policy to meet your needs.
Health Plan Reinsurance
Physicians Insurance also provides reinsurance solutions to health plans. Our reinsurance solutions provide financial protection from catastrophic or other unexpected losses from health plan members. We create the best possible coverage options that accommodate a health plan’s risk appetite and mitigate the financial exposure.
Provider Excess
Physicians Insurance has been providing insurance solutions to providers in risk-based contracts since 1996. Our stop-loss solutions help providers succeed in these arrangements by providing financial protection from catastrophic or other unexpected losses. Whether a provider needs protection for a specific episode or bundled payment arrangement, a single capitated contract or multiple contracts, we create the best possible coverage options that accommodate a provider’s risk appetite and mitigate the financial exposure.
Bundled Payments
Value-based healthcare is affecting how providers view public and private reimbursement mechanisms. Although the transition away from fee-for-service has been slow, alternative payment models are gaining speed. One of these payment models is Bundled Payments. Under Bundled Payments the providers are reimbursed for a specific episode of care. This reimbursement is allocated to all of the providers participating in the episode of care and for a determined amount of time. Not all Bundled Payments are structured the same way and whether public or private, Bundled Payment models can require providers to be at risk.
Whether you are seeking downside financial risk protection for a specific episode of care arrangement (bundle), for a group of episode of care arrangements, for all episode of care arrangements, for a particular provider or facility, or just want a tailor-made solution, Physicians Insurance is the right answer for you. In addition, our strategic partners can assist you with episode of care (bundle) evaluations and selection as well as provide you with the clinical and administrative tools to advance the quality of care for your patients.
Employer Medical Stop Loss
Providing healthcare benefits has been a major tool by employers to attract and keep talent within their workforce. This tool however, can be a very expensive and complex one depending on the structures available to the employers. One of these structures is self-insurance, in which the employer assumes the financial risk for providing healthcare benefits to its employees. Employers may have many reasons for opting to self-insure, which could include amongst other reasons, improved cash flow, custom-designed health plans, and greater control and tax savings. To help stabilize results, employers can opt to purchase stop loss insurance above a set deductible. Physicians Insurance has been providing stop loss insurance to self-funded employers since 2002. Whether your stop loss needs are local in the Pacific Northwest or elsewhere, Physicians Insurance will partner with you to customize a policy to meet your needs.
Health Plan Reinsurance
Physicians Insurance also provides reinsurance solutions to health plans. Our reinsurance solutions provide financial protection from catastrophic or other unexpected losses from health plan members. We create the best possible coverage options that accommodate a health plan’s risk appetite and mitigate the financial exposure.
Provider Excess
Physicians Insurance has been providing insurance solutions to providers in risk-based contracts since 1996. Our stop-loss solutions help providers succeed in these arrangements by providing financial protection from catastrophic or other unexpected losses. Whether a provider needs protection for a specific episode or bundled payment arrangement, a single capitated contract or multiple contracts, we create the best possible coverage options that accommodate a provider’s risk appetite and mitigate the financial exposure.
Bundled Payments
Value-based healthcare is affecting how providers view public and private reimbursement mechanisms. Although the transition away from fee-for-service has been slow, alternative payment models are gaining speed. One of these payment models is Bundled Payments. Under Bundled Payments the providers are reimbursed for a specific episode of care. This reimbursement is allocated to all of the providers participating in the episode of care and for a determined amount of time. Not all Bundled Payments are structured the same way and whether public or private, Bundled Payment models can require providers to be at risk.
Whether you are seeking downside financial risk protection for a specific episode of care arrangement (bundle), for a group of episode of care arrangements, for all episode of care arrangements, for a particular provider or facility, or just want a tailor-made solution, Physicians Insurance is the right answer for you. In addition, our strategic partners can assist you with episode of care (bundle) evaluations and selection as well as provide you with the clinical and administrative tools to advance the quality of care for your patients.
COVERAGE HIGHLIGHTS
Employer Medical Stop Loss:
- Choose from a full range of contract claims bases: 12/12, 12/15, 12/18, 12/24, 15/12, 24/12, and PAID.
- Lock in rates as early as 120 days in advance of policy effective date.
- Choose from a full range of specific deductible levels: $50,000 on up to $500,000.
- Include an Aggregating Specific Deductible Endorsement. This option may enable employers to reduce specific Per Employee per Month (PEPM) rates by taking on additional specific liability.
- Establish simultaneous funding on specific reimbursement. This value-added service allows employers the option to submit a specific claim for reimbursement at the time high-cost member claims are paid.
- Include a Monthly Aggregate Deductible Accommodation (MADA) Endorsement. This allows employers the option to submit an aggregate claim for reimbursement during the policy year instead of waiting for policy year-end.
Health Plan Reinsurance:
- Annual limits from $1,000,000 to unlimited
- Deductible elected based on the health plan’s risk tolerance.
- Other available features include an experience refund, aggregating specific deductible, retained corridor, and increased percentage payable (for following cost containment recommendations).
Provider Excess:
- Annual limits from $1,000,000 to unlimited
- Deductible elected based on provider’s risk tolerance.
- Other available features include an experience refund, aggregating specific deductible, retained corridor, and increased percentage payable (for following cost containment recommendations).