To help self-funded health plans limit liability on catastrophic or high-cost claims, Diversified Group helps the plan secure Medical Stop Loss insurance. This protects individual plan members and the entire covered population against higher-than-expected healthcare costs.
Specific Stop Loss protects the plan against catastrophic claims for any individual during a policy year.
The employer funds claims up to the pre-determined stop loss amount, with specific stop loss coverage paying any claims above that.
Aggregate Stop Loss
Through risk analysis, Diversified Group determines the maximum amount of claims the plan can afford for the entire covered group.
When the annual claim maximum exceeds the predetermined level, Aggregate Stop Loss coverage reimburses the plan for claims exceeding that level during the policy term.
With 50+ years of experience, Diversified Group takes the complexity out of Stop-Loss insurance. First, we work to obtain a Stop-Loss Contract consistent with your plan design and risk tolerance. Then our claims administration professionals process and pay claims in compliance with the terms of the contract and your plan document.
Diversified Group maintains an internal Compliance Department dedicated to helping your health plan maximize Stop Loss reimbursements and avoid costly litigation.
Analysis and submission of claims is the basis upon which Stop Loss carriers evaluate our performance. Strict quality control measures help us ensure prompt, accurate reimbursement.
Decades of experience in data gathering and claims analysis enable Diversified Group to address the employer’s needs by easing the burden associated with compliance and disclosure.
Daily monitoring and multi-layered review of high-dollar claims help your plan identify exactly how your healthcare dollars are being spent and avoid over-billing. To better serve the employer, Diversified Group also maintains coverage and provides a consolidated bill and remittance to the stop loss carrier.
Having earned the trust and confidence of many “best in class” Stop-Loss carriers , we use our experience and these strategic partnerships to obtain the best possible contract terms for your plan.
Downloadable: Free Stop-Loss Chart!
Self-insured health benefit plans offer greater flexibility and an opportunity for savings.