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1) What kind of Stop Loss coverage is offered?
We offer AGGREGATE Stop Loss coverage for Rx Plans on a 12/12 basis. We do not offer Specific Stop Loss Insurance. FAQ Index


2) What is a 12/12 Program?
The 12/12 Program requires that all claims be incurred and paid within the 12-month contract period. FAQ Index


3) Is Stop Loss coverage offered on all Rx Plans?
We do not offer Stop Loss on Voluntary (Employee pay all) Rx Plans. We do not offer coverage without a significant contribution by the Employer towards the cost of the program and significant participation by the Employees. Also, the Carrier reserves the right to refuse to provide coverage when, in their judgment, an inappropriate level of risk exists or a true Employer/Employee relationship is not present. FAQ Index


4) What is the Minimum Annual Premium?
The Minimum Annual Premium is $1,500 (regardless of group size). FAQ Index


5) When is the Premium due?
At least 95% of the Estimated Annual Premium must be submitted with the signed Preliminary Application. Prior to the Anniversary Date, we will request the “balance” of the earned premium. For Stop Loss cases with Premiums in excess of $50,000, we will consider an alternative payment arrangement. FAQ Index


6) How small of a group can be underwritten?
We don’t have a minimum group size, but many States restrict Stop Loss Insurance to groups with 50 or more employees. Also, due to Minimum Annual Premium and Aggregate Attachment Point Requirements, a prospect with less than 50 Employees can be a difficult sell. FAQ Index


7) What is the Minimum Annual Aggregate Attachment Point?
The Minimum Attachment Point is typically 125% of the anticipated claims. FAQ Index


8) What is the Minimum and Maximum Benefit?
The Minimum Benefit, no matter how small the group, is $50,000. The Maximum Benefit, no matter how large the group, is $1,000,000. The Stop Loss Benefit is typically one-times the Annual Aggregate Attachment Point, subject to the minimum/maximum amounts cited herein. FAQ Index


9) How do I request a Quote?
We will gladly mail, fax or e-mail the “Request for Quote” form to you. You can also click here to visit the web based form which can be downloaded and printed or filled out and submitted on-line. FAQ Index


10) What information needs to be provided to receive a “Quote”?
We need the Benefit Plan Description, employee census/eligibility data and paid claims data for the most recent 12 months (or more). We would like this claims data on a month by month basis. If claims data is not available, a complete employee census by Age Group and Dependent Coverage status is required(Please refer to the Request for Quote form for details). FAQ Index


11) When is the Stop Loss Insurance confirmed?
A Confirmation of Insurance (Binder) is issued upon receipt of the signed Preliminary Application, at least 95% of the Estimated Annual Premium and a current census. FAQ Index


12) When is the Stop Loss Policy issued?
The Stop Loss Insurance Policy is issued after all of the following has been received and reviewed; the signed Preliminary Application, a check in an amount equal to at least 95% of the Estimated Annual Premium and the Summary Plan Description (SPD) for the group. FAQ Index


13) Who is responsible for “funding” claims?
The Employer is responsible for “funding” all claims, even for claims in excess of the Attachment Point. The Stop Loss Policy will “reimburse” the Employer at the conclusion of the contract period for claims “incurred and paid” during the contract period that are in excess of the Attachment Point. Reimbursement is made after receipt and review of paid claims data to verify incurred/paid dates and plan maximum limits. In an extreme situation, we may require a claims audit prior to paying the Stop Loss reimbursement. We do not offer a Monthly Accommodation arrangement. FAQ Index


14) How is the Attachment Point determined?
The sum of all the Monthly Aggregate Attachment Points for each month of the Policy Year will be the Annual Aggregate Attachment Point under the policy. However, the Annual Aggregate Attachment Point will never be less than the Minimum Aggregate Attachment Point shown in the Schedule of Stop Loss Insurance. FAQ Index


15) Are Claims and enrollment data required after the Stop Loss Policy is in place?
We require the TPA to provide MONTHLY enrollment and paid claims data and we will provide the TPA with the appropriate Monthly Claims Reporting Form. The monthly reporting of enrollment/paid claims data is required by the Carrier and is utilized in computing the Renewal Attachment factors. FAQ Index


16) What happens if the Employee Enrollment changes?
In those instances where the Employee population changes dramatically during the course of the policy period, we may advise the TPA that the case requires additional premium. Any additional premium required is due within 30 days of said notification. FAQ Index


17) Is the TPA paid by Dentafits?
In consideration of the TPA providing all of the above reports, we customarily pay the TPA an “Administrative Allowance”. For Stop Loss cases where premiums are in excess of $50,000, the Administrative Allowance is negotiated. FAQ Index

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