Since the Affordable Care Act was passed in 2010, its requirements have challenged many organizations with self-funded health care plans. Two of the most significant changes for unions are the removal of annual claim limits and the removal of lifetime coverage maximums.
In the past, self-funded healthcare plans mitigated the risk of large claims by limiting annual maximums. With the mandated removal of those limits, plans need to consider different approaches to minimizing their risk. Stop loss coverage is an effective way to protect your plans from increased exposure to high risk/dollar claims. Even if your plan's network limits claims, large out-of-network claims still pose a risk.
We've already seen a steady rise in claims exceeding $500,000 and $1 million since 2007. Even if your plan has strong cash reserves, stop loss insurance is a risk management tool. Why risk paying millions of dollars for one claimant instead of passing that cost onto a third party stop loss provider?
When you purchase stop loss coverage from Union Labor Life, you gain access to experts in handling large dollar claims and cost-containment initiatives. When high dollar claims are submitted, we work in collaboration with our cost-containment partners, administrators and healthcare providers to assess the true costs of the claim.
For example, a plan received an in-patient hospital bill for $198,000. The PPO offered a discount to reduce the plan's liability to $147,000. Our experts reviewed the bill and found undocumented charges. After we identified the billing errors, the plan reduced its overall cost to only $62,000.
We also work with plan administrators to ensure that claims are accurate and that your health plan is billed correctly. Recently, a plan was billed for a specialty drug treatment by its pharmacy benefit manager (PBM). The plan's third-party administrator paid the $1.2 million bill and then submitted a stop loss claim to Ullico. After our staff identified significant billing and payment errors made by the PBM, we alerted the third-party administrator, who then recovered all but $14,000 of the plan's money.
To learn more about how stop loss coverage can help your plan, visit www.ullico.com/lh/medicalstoploss or contact Larry Paradise, Vice President of Group Sales, at 800.431.5425.