Stop Loss Insurance
Protection for Self-Funded Employers
With nearly 35 years in the Stop Loss Insurance market, HM Insurance Group works to deliver smart solutions, exceptional performance and unparalleled support. You can tailor our Stop Loss coverage to satisfy your clients’ level of risk tolerance and trust that our underwriting experts are working to protect policyholders’ financial wellbeing based on individual experience and group dynamics. With a wide range of deductibles and contract periods, our Stop Loss plans can be structured to meet specialized needs and mitigate potential claim risks.
As a leading Stop Loss carrier and direct writer, we work to optimize coverage through experienced risk management, excellence in operational performance and successful cost containment practices. You can rely on quick, accurate claim payment and an exceptionally high level of performance that enables you – and your clients – to focus on your own business goals. Talk with one of our experienced leaders to learn more about our approach to the market and build a relationship that lasts.
A Solid Contract
HM offers clients a Stop Loss policy that provides clarity, financial protection and choice. We know that the contract is the core of the carrier-client relationship and the foundation for mutual obligations. Our streamlined contract with limited exclusions helps to ensure your clients know their coverage details. It’s written in language employers understand, mirrors the underlying plan and offers choices for customized Stop Loss protection.
Claim Services from Dedicated Teams
Since we underwrite to pay claims, not to dispute them, you can count on responsive, timely administration of Stop Loss insurance claims. Our dedicated claims team uses streamlined processes to provide accurate and efficient reimbursement. Highlights include:
- eClaims and low documentation submission options
- Access to Centers of Excellence
- Out-of-network discount negotiation services
- Subrogation recovery
- Collaboration on unusual/questionable services
We know that the heart of a smart business decision is the integrity of the transaction. Guided by knowledge and experience, we make sound, disciplined decisions to guard the financial health of our policyholders. When you work with HM, you can be confident in the quality of what you are delivering to your clients.
Disclaimer Coverage is underwritten by HM Life Insurance Company, Pittsburgh, PA, in all states except New York under policy form series HL601 or HMP-SL (11/16) or similar. In New York, coverage is underwritten by HM Life Insurance Company of New York, New York, NY, under policy form series HL601 or HMP-SL (11/16) or similar. The coverage requested may not be available in all states and is subject to individual state approval.
Stop Loss Insights
What Does Unlimited Mean?
At HM Insurance Group (HM), we’re very proud of our financial strength. Our Stop Loss paper is rated “A” by A.M. Best, and we have a combined surplus of more than $1,000,000,000. That’s a lot of zeroes. This capital is the financial bedrock of the promise we make to employer groups – we will pay their claims. The Stop Loss market has changed a lot in the past ten years. Prior to the passage of the Affordable Care Act (ACA) in 2010, we issued limited policies, meaning they had annual or lifetime policy maximums of $1,000,000 or $2,000,000. As an underwriter at that time, it was hard to envision claims reaching those policy limits. But now it’s something that happens with frequency.Continue Reading
Why Data Matters
Data. Big data, small data – it doesn’t matter. All data is currency in today’s world. In the insurance business, data is the word that sets the hearts of actuaries and underwriters aflutter. It’s the facilitator to their ability to deduce, determine and decide what moves to make. But further, to their Stop Loss companies, data quite likely is the difference between a win and a loss. And I don’t mean just winning an account or not – I mean winning financially or taking a loss – and that extends to everyone involved.Continue Reading
Integrating RxOps for Cost Management Solutions
As a pharmacist, in the past 20-plus years, I’ve owned my own pharmacy, worked for a PBM (pharmacy benefit manager), served as a consultant to health plans and more. Now, I find myself in the operations department of a Stop Loss carrier. As pharmaceutical costs continue to rise and new drugs debut with million-dollar price-tags, the market is seeing greater catastrophic claims expenses – and I’m working to share my industry knowledge and understanding of pharmaceutical costs and use across the client population.Continue Reading