In Canada, Employers have many choices as to how to provide their employees with Extended Health and Dental Care including Fully Insured Plans and Self-Funded Plans. For the Employer, one of the most important deciding factors in choosing and establishing a plan design will be the decision on how to finance the plan and its expenses. Self-Employed Business Owners have discovered that they are able to choose a Self-Funded plan that allows them to spend their hard earned dollars when they choose and on what they choose…
Over the past couple of decades, the Self-Funded Employee Benefit plan where a Third Party Administrator adjudicates and reimburses claims, has become a very popular choice for employers that are looking to gain control of their overall benefit plan and its predictable claims & costs. They have discovered that opting for the Self-Funded model has provided them with affordability & sustainability, as well as the ability to reduce plan premiums, lower administrative costs and improve cash flow.
However, the employer is still desiring to be able to provide financial protection against large or catastrophic medical claims that may or may not occur. But the reality is, the employer can be fully responsible if medical claims are higher than expected with even just one large claim creating a serious financial drain on the company, particularly if the company is a smaller or mid-size company.
SOLUTION: Stop Loss Insurance is designed to protect the self-funded employer from the financial liability for the high costs that may occur due to unexpected or catastrophic claims from their employees OR for the small self-employed business owner who cannot afford to pay for their catastrophic claims. Stop Loss Insurance will help you protect the financial integrity and sustainability of your self-funded benefit plan for years to come!
A Stop Loss Insurance Definition:
A medical Stop Loss Insurance policy protects employers from assuming all of the liability for losses that result from an unexpected amount of claims – either from an individual employee or the entire employee group as a whole. Under a Stop Loss Insurance policy, you are not responsible for claims that exceed certain pre-set limits for the policy years such as defined benefits per person or annual benefit maximums. If claim expenses go above these limits, the Stop Loss Carrier will assume the liability. The seCUREme plans from Health Risk Services mitigate the employer’s financial risk when selffunding a medical plan by providing insurance protection against unpredictable and catastrophic claims.
Most often these large claims are due to unexpected needs for expensive medications for either short term or long periods of time. seCUREme allows employers to provide extended benefits to cover these situations within a self-funded plan, while eliminating the financial risk to the business. Small and mid size businesses can now offer health benefit plans that previously only large companies could afford. For both the employer and the self-employed, seCUREme acts very much like auto insurance where rare health catastrophic claims are covered after an initial deductible amount is paid. The deductible amount is covered by the self-funded health plan.
The seCUREme Catastrophic Coverage is designed to protect the self-employed and small businesses and can be attached to either a Cost Plus Plan or a Health Spending Account to provide full benefit coverage with extended maximums. Please click HERE to review the full description of seCUREme Catastrophic Coverage.
The seCUREme Comprehensive Stop Loss Plan is designed for businesses with 5 employees or more from mid size to large companies. It has been created to mitigate the financial risk of the employer while still being able to offer their employees attractive and flexible health benefit plans. Please click HERE to review the full description of seCUREme Comprehensive Stop Loss Plans.
The seCUREme Prescribed Drugs Stop Loss Plan is designed to allow Employers to design their Traditional Plans with reasonable & sustainable Drug Caps while giving their employees the peace of mind of knowing that they are covered should they require extended Drug coverage. Please click HERE to review the full description of the seCUREme Prescribed Drugs Stop Loss Plan.
Stay tuned for the introduction of our TOTALHealth™ program! To be launched in 2023.