Our services
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:
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Plan mirroring
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Specific claim advance
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Early pricing lock at 60 days
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Actively-At-Work automatically waived (with approval of disclosure)
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Renewal coverage does NOT require additional disclosure
Access to preferred risk management vendors for:
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Dialysis repricing/negotiations
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Transplant and Oncology COE network
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Emerging therapy solutions/alternative
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Bill audit/negotiation tools
The following are available on a case-by-case basis:
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90-day and 120-day early pricing lock
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Rate cap
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No new laser
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Aggregate accommodation
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.
OUR SERVICES
Underwriting Services
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.
Coverage Options:
Minimum Group Size: 50+ covered employees (lower on an exception basis)
Minimum Specific Deductible: $25,000 (lower on an exception basis)
Contract Periods:
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
Policy Limits:
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)
Optional Provisions:
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 SERVICES
Administration
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.
OUR SERVICES
Claims
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:
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Medical and Disclosure review and counsel
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Support for Plan Document Amendments through partner fiduciary legal firm
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Claim evaluation to support client decision process
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Specialty care management and cost mitigation strategies
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Contracted Centers of Excellence for Transplantation, Oncology, Dialysis and Specialty Rx
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Neonatology Management
