Medical Stop Loss
Prodigy offers clients a range of stop loss solutions not commonly found in the reinsurance industry, delivering expertise in the integration of captives, level funding in addition to traditional stop-loss.
Every policy includes the following:
Specific claim advance
Early pricing lock at 60 days
Actively-At-Work automatically waived (with approval of disclosure)
Renewal coverage does NOT require additional disclosure
Access to preferred risk management vendors for:
Transplant and Oncology COE network
Emerging therapy solutions/alternative
Bill audit/negotiation tools
The following are available on a case-by-case basis:
90-day and 120-day early pricing lock
No new laser
We encourage brokers and TPAs to contact our sales or underwriting team to discuss alternative strategies using captives, split deductibles, scheduled reimbursements or other flexible options.
The underwriting of each group includes an review and analysis of month by month claims, ongoing large claims, census and enrollment history and plan design. Our underwriters then apply time tested principles and actuarial modeling to develop competitive quotes specific to each group.
Minimum Group Size: 50+ covered employees (lower on an exception basis)
Minimum Specific Deductible: $25,000 (lower on an exception basis)
New business: 24/12, 18/12, 15/12, 12/12, 12/15, 12/18
Renewal Business: All of the above plus Paid and 12/24
Specific Coverage: Unlimited
Aggregate Coverage: $1,000,000 per policy year ($2,000,000 available)
Aggregate Only Coverage: 12/12, 12/15, 12/18 (available for level funded programs)
Specific Coverage: Specific advance
No Laser on renewal (Laser alternatives available)
Aggregate Coverage: Aggregate Accommodation Terminal Liability
Our primary goal is to issue quotes that offer an employer the most cost-effective solution for their health plan, achieving this balance and long-term stability through a blend of standard underwriting practices and utilization of marketing leading risk management strategies.
Our administrative team delivers more than 100 years of compliance, finance, policy management and reporting to every client. To enhance the customer experience, we have implemented a fully automated administration system which ensures timeliness of policy issue, premium billing & processing, and dispute resolution.
Management of our claim department is outsourced to Corporate Benefit Audits (CBA), a leading firm in the review and adjudication of large claims and aggregate claims for direct stop-loss insurers and market leading MGUs. This ensures that employers receive a fair and unbiased interpretation of their claims without unnecessary delays. This shared team of registered nurse and physician reviewers plus seasoned claim managers deliver unparalleled expertise in reconciling an employer’s Plan Document to the medical stop-loss policy.
Claim services include:
Medical and Disclosure review and counsel
Support for Plan Document Amendments through partner fiduciary legal firm
Claim evaluation to support client decision process
Specialty care management and cost mitigation strategies
Contracted Centers of Excellence for Transplantation, Oncology, Dialysis and Specialty Rx