Rather than paying monthly premiums to a health insurance carrier like Aetna or Blue Cross/Blue Shield, some companiesoffer health insurance directly to their employees and pay health care claimsas they happen. Stop loss insurance reduces the financial risk for these “self-insured”employers by reimbursing them for claims that are over aspecific, pre-determined dollar amount.

Here’s an example:
An employee whose health care is covered for up to $100,000 has a heart attack and $175,000 in health care claims. With stop-loss insurance, the employer pays $100,000 and thestop-loss carrierpays $175,000.

What we do:
Ourpartner, US Fire, acts as the insurance carrier and pays the claims. As the underwriter, we evaluate insurance applications and determine coverage amounts and premiums, but we also find ways to lower the amount of claims, and make sure patients get the care they need. Partners also handles stop-loss insurance claims administration. We do everything a carrier does, with the exception of actually paying claims, all in-house, with a caring and collaborative team. Our partner, US Fire, acts as the insurance carrier and pays the claims.