Stop Loss Insurance

What is stop loss insurance?

There are two types of stop loss insurance that Cigna Healthcare offers:

Individual Stop Loss (ISL)

ISL is stop loss coverage written to protect a self-funded medical plan by limiting an employer's claim liability on each individual to a set dollar amount per policy year.

Aggregate Stop Loss (ASL)

ASL is stop loss coverage written to protect a self-funded medical plan by limiting an employer's claim liability for their entire covered population to a set dollar amount per policy year.

For small to medium-sized employers, Cigna Level Funding^® and Cigna Healthcare ASO Plus include Individual and Aggregate Stop Loss automatically.

Types of Stop Loss Contracts

Incurred Contracts

We offer an Incurred Contract with an infinite terminal liability protection period where claims accumulate to stop loss limits based on the incurred date (i.e. date of service). With this contract type, eligible claims incurred during a policy year will accumulate together with no ISL limit reset, regardless of when the claim is paid.

The incurred contract is available with ISL and ASL, and:

• Eliminates coverage gaps related to claim payment timing
• Eliminates the need for run-out protection or run-in with a new carrier
• Eliminates the need for a maturation adjustment at first renewal

Paid Contracts

We offer a Paid Contract where claims accumulate to stop loss limits based on the paid date. The paid contract covers eligible claims paid during the active policy year, so long as the claims were incurred after the original policy effective date. The paid contract is available with ISL and ASL.

Options for Stop Loss Contracts

We also offer additional stop loss contract options designed to satisfy your unique coverage needs.

• Run-in and Run-out Protection - for employers transitioning to and from stop loss carriers
• Tiered Pooling and Aggregating Specific - for employers willing to take on more risk for a lower rate
• Renewal Advantage - for employers seeking to limit future exposure by capping the renewal rate increase at 45%¹ (eliminates new lasers and pooling point increases at renewal)
• Dividend Option - for employers who want an additional refund if they have good claims experience for one, two, or three years

Stop Loss Firm Quotes

Upon accepting our firm quote, your rates, terms and conditions become final and your premium for the policy period may never increase. We take on 100% of the covered claims liability.

Some firm quotes in the marketplace may only be willing to lock-in rates, which could leave room to alter other terms and conditions closer to the start date of your policy. Our early lock-in ensures that rate, terms and conditions are finalized — with no need for review of updated large claim information as your policy start date approaches. Signed disclosure forms are never required, even when you have employees with ongoing large claims.

Benefits of Integrating Stop Loss With Medical Plans

Stop loss insurance integrated with a self-funded medical plan ensures alignment between policies and enables:

• Consistent coverage - Eligibility and terms such as medical necessity and experimental and investigational treatment are consistent between your medical plan and stop loss policy, ensuring identical coverage decisions.
• Simple claim management - Covered claims are reimbursed automatically with no claim filing or notification necessary.
• High-speed reimbursement - Reimbursements are processed within two to five calendar days from claim payment, and large claims over $150,000 are often credited same day or before the provider payment debit.
• Portfolio management tools - Receive advance notification when stop loss reimbursement has been scheduled for large claims, which will indicate dollar amount and estimated settlement date.²