Stop Loss Insurance Defined
When changing Stop Loss Carriers, there are always some claims still not received and processed by your current administrator during your contracted plan year. You need to be sure these claims are the responsibility of either your current Carrier or you new Stop Loss Carrier.
If you have a fully insured plan, the present insurer is responsible for paying claims incurred prior to the change date. If you are self-funded, you need to determine who you want to administer, and who can assume the risk for these outstanding claims. If you select the current administrator to pay for those claims incurred prior to the change, then you have entered into a “run-out” contract. If the new administrator is to process and protect the plan against the claims incurred prior to the change, then you have entered into a “run-in” contract. The following are examples of various types of contracts offered:
Incurred – the date on which a covered medical service is rendered.
Paid – the date payment checks, drafts or electronic payments have been issued, mailed or otherwise delivered to the payee with sufficient funds on deposit. Note: Each carrier has particular wording on the definition of a paid claim and it is important to read the policy and understand the provisions.
Other available “run-out” contracts available are:
Other available “run-in” contracts available are: