As brokers look to provide tangible value and retain clients, here’s an important question to consider:
Have you done everything you can to protect your self-funded clients from the headaches and financial impact of catastrophic claims?
When legitimate catastrophic claims occur, employers should not have to worry about whether they will be reimbursed, nor should they be subjected to an unreasonably long delay in receiving reimbursement. If these things happen and the employer becomes frustrated – right or wrong – they’re likely to blame their broker.
“If the claims process goes badly, either through a long, arduous and unreasonable delay, or worse, a claim denial, the customer will rightly ask why they were placed with that particular carrier,’” said Gerald Gates, president of Stop Loss Insurance Services, the nation’s leading stop-loss wholesaler. “Not all stop-loss carriers and policies are created equal. Clients have and will fire brokers in these instances. Therefore, brokers should not take the decision of where they place their valued clients’ stop-loss coverage lightly; it may come back to hurt them.”
Self-funding with appropriate stop-loss coverage in place is a smart and cost effective strategy for many employers. There are a number of things the benefits professional should do to ensure the best possible outcome for their self-funded client. Here are three important tips:
1. Don’t be passive: Closely monitor and analyze your clients’ claim experience at least every month.
2. Communicate early and often: Brokers need to gather information to prepare themselves and their clients if a poorly performing case is up for renewal. With business that has to be resold each year, communication is key. Beyond compiling and analyzing monthly claim data, keep your client informed about trends. If claims are running higher than expected at mid-policy year, meet with your client to review results; most employers welcome this information and want to develop strategies to address problems. Don’t let a higher than expected (but fair) renewal quote come as a shock. If there is potential for a healthy rate increase, discussing it along with strategies to address it is critical.
3. Mitigate risk and maximize outcomes: This can be achieved by utilizing specialized products and services that can impact costs in the most common causes of catastrophic claims such as organ transplant, specialty drug therapies, cancer treatments, renal disease/dialysis, etc. Having access to vendors who can coordinate these programs or connect you to them is necessary in limiting the impact these claims can have on your client’s funds. Talk with stop-loss carriers, trusted intermediaries, and even case management companies to develop a strategy should a singular claim event or chronic condition occur. Knowing the right steps to implement these at the time they happen - from releases needed to which entity should take point in which situation, will allow for the best engagement and results for your client and their members.
No one wants to see catastrophic claims occur. When they do, it is critical that the benefits professional has put the right measure in place to protect the client’s assets, effectively manage the claim, achieve positive outcomes, and ensure fair and fast claim adjudication. The timely and proper handling of claims can be a critical “moment of truth” for self-funded clients, and benefit professionals must continually be looking to support their clients when they need them most.
Legal Disclaimer. Views expressed here do not constitute legal advice. The information contained herein is for general guidance of matter only and not for the purpose of providing legal advice. Discussion of insurance policy language is descriptive only. Every policy has different policy language. Coverage afforded under any insurance policy issued is subject to individual policy terms and conditions. Please refer to your policy for the actual language.
(c) 2017 AmWINS Group, Inc.
As a result of the COVID-19 crisis, our industry is facing a broad array of challenges that impact insureds of every size and in every industry. In the first of a series of webinars, we hear from an economist on the financial impacts of COVID-19 and what we can expect in the future. This webinar is intended to complement your conversations with clients about how to plan for the next 12 to 24 months.
As the healthcare industry remains on the front lines of battling the COVID-19 pandemic, staying abreast of the changing landscape and how the insurance market is adapting is critical to ensure new exposures are covered and renewals are successfully placed. In this article, our specialists share what they are seeing in the Healthcare and Senior Care markets, tips for risk control and mitigation, and how to get the best results for insureds.
The disruption to business and everyday life caused by the coronavirus (COVID-19) pandemic is resulting in an economic impact for insureds. Much of this disruption is likely not covered by insurance. We have consulted with several AmWINS insurance specialists across the Property, Casualty and Professional Lines sectors and offer a COVID-19 update.
Over the last few years, the legal cannabis industry has seen rapid growth and had a significant impact on the U.S. economy. With states continuing to legalize its use, insurance needs for cannabis-related businesses are becoming a popular topic of discussion. This article examines the evolving cannabis industry by exploring five key issues impacting coverage.
Construction contract negotiations, which determine the kind and amount of insurance required for a construction project, can be time-consuming, complicated and frustrating. Project owners require contractors on a project to name the project owner as an additional insured on the contractor’s casualty insurance program. It's important that both project owners and contractors understand the coverage provided by these additional insured endorsements. This article discusses four common ISO additional insured endorsements related to commercial general liability policies purchased by contractors, including their limitations, conditions and exclusions.
Parametric insurance is an innovative product that functions differently than traditional insurance by covering the impacts of an event and not just losses sustained to an asset. Proceeds of the policy are paid quickly and can be used flexibly to cover any expense associated with the triggering event. Coverages can be designed to capture the impacts of natural perils and other forms of non-damage business interruptions such as future epidemics. Learn how the parametric landscape has and will continue to play a major role in improving coverage and the recovery experience.
The theories of recovery, as well as the ensuing loss provisions, contained in property insurance policies are often complex and, at times, seemingly in conflict. Although a policy may not directly address these theories, their application by courts plays a significant role in the coverage determination process after the claim. It is essential that brokers understand the primary theories of recovery – Efficient Proximate Cause, the Concurrent Causation Doctrine, and the Anti-Concurrent Causation Doctrine – in order to navigate the challenging post-claim process and effectively serve their clients.