Stop-Loss Coverage

  • LifeWise Assurance Company provides self-funding organizations the secure coverage they require. As a member of the Premera family of companies, we consolidate multiple medical stop-loss options to deliver coverage that meets the specific needs of employers.

    When LifeWise Assurance Stop Loss insurance is purchased with a Premera company as the claim administrator, the medical plan document and the stop-loss contract align to provide truly gapless coverage. Network savings, claim and medical management services, and funding tools (typically contracted through different carriers) are consolidated, simplifying administration.

    If Premera is not the claim administrator, LifeWise will make every attempt to provide gapless coverage, as permitted by state insurance regulators. Upon request, LifeWise Assurance will review plan documents for exclusions or limitations that cannot be accommodated under the stop-loss contract. Most packages include both specific stop-loss coverage for individual catastrophic claims and aggregate coverage that kicks in when cumulative claims exceed a predetermined limit.

    Benefits that may be included in LifeWise Assurance Stop Loss:

    • Deductible levels ranging from $20,000 to $500,000 based on group size and needs, subject to state requirements
    • Aggregate stop-loss coverage from 120% to 200% of expected claims, subject to state requirements
    • Standard stop-loss contract basis of 12/12 first year, which would renew to a paid contract; other options available upon request
    • Independent claims review and audit services at no extra charge

    Optional benefits include:

    • Aggregate monthly accommodation
    • Advanced funding for specific stop-loss
    • Aggregating specific stop-loss
    • Terminal liability protection for aggregate and specific coverage

    Self-funding advantage

    More and more employers are taking advantage of the savings and control that come with funding their own health coverage. Reliable, flexible medical stop-loss coverage is making this option increasingly viable.

    Some of the advantages of self-funding include:

    • Greater cost control – You can fund claims as they are due, rather than paying premiums in advance.
    • Greater flexibility – Self-funding is exempt from state coverage requirements, allowing you to tailor coverage to specific needs.
    • Tax savings – Eliminates most premium taxes. There is no premium tax on self-insured claim expenditures. Premium tax is applied only to the stop-loss premium, which is a fraction of a fully insured premium. In addition, the insurers’ fee under the Affordable Care Act does not apply to self-funded claims.