Medical Stop Loss Insurance

A simple solution for smart health plan sponsors.

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It only takes a few critically ill members or dependents to strain your Taft-Hartley plan’s financial assets or, worse, deplete the entire health and welfare fund.

Medical stop loss insurance protection can help limit the impact of a potentially large financial liability. Stop loss insurance reimburses your health plan if claims exceed certain deductibles. This coverage provides an important layer of protection against large or unforeseen catastrophic claims that could threaten your fund or plan.

With 95 years of experience serving the union marketplace, The Union Labor Life Insurance Company is a carrier you can trust. Our expert underwriters and staff understand what it takes to protect Taft-Hartley plans. We offer broad coverage, quick policy installations and customer service that does not end once you have purchased coverage. When large claims do occur, we provide access to leading professionals in the medical cost containment industry, to help you manage plan costs through cost-effective care alternatives.

Plans Offered

Stop loss coverage is available to reimburse your plan for medical and prescription-related expenses.

  • Specific Stop Loss

    Protection from large medical claims on any individual plan member or dependent

    • Get reimbursed when claims and covered expenses exceed a predetermined dollar amount
    • Purchase separately or with aggregate stop loss
    • We offer a full range of specific and aggregate contracts including paid, run-in and run-out contracts from 24/12 to 12/24

  • Aggregate Stop Loss

    Protection from medical claims that are higher than expected for an entire group

    • Get reimbursed when total claims exceed a predetermined amount or aggregate attachment point
    • Available when bundled with specific stop loss coverage

Blog

Cost Containment Strategies for Union Benefit Plans

Protect your health and welfare funds from catastrophic claims. The rising cost of health care puts union trustees and fund administrators in a delicate position. On one hand, union members have come to enjoy the benefits of self-funded plans. On the other hand, self-funded plans face unique challenges. Because the union takes on the financial…

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Policy and Funding Features

We continue to respond to the changing healthcare marketplace as provisions and mandates of healthcare legislation are adopted, revised or repealed. We offer standard unlimited lifetime maximum coverage and optional annual maximums, which include unlimited coverage per person for each policy year. In addition, we offer several purchasing options from which to choose:

  • Dividend Choice Plans: We offer premium dividends as well as experience-rated dividends for qualified groups.
  • Aggregating specific rate caps

We’re Experienced in Cost Containment Strategies

From helping plans properly negotiate service fees with network providers and third-party administrators, to assisting in identifying potentially fraudulent billing practices and abuses, Union Labor Life works in partnership with policyholders to help them achieve the level of control they need to manage large claim costs, maximize benefits and optimize plan performance. Types of cost containment programs available to policyholders include:

  • Bill re-pricing

  • Discount negotiations

  • Bill reviews and line-item audits

  • Case management

  • Medical reviews

  • Specialty care management

Resources

Brochure – Medical Stop Loss
Brochure – Cost Containment
Administrative Guide
Administrator Questionnaire
Specific Stop Loss Claim: Initial Claims and Notices
Specific Stop Loss Claim: Subsequent Claims
Stop Loss Aggregate Claim: Monthly Accommodation
Stop Loss Aggregate Claim: Year End Aggregate
Premium Worksheet
Work Status Questionnaire
Third Party Liability Questionnaire
Right of Recovery / Subrogation Agreement
Subrogation Agreement

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