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1) What kind of Stop Loss coverage is offered?
We offer AGGREGATE Stop Loss coverage on either a 12/12 or 12/15 basis. We do not offer Specific Stop Loss Insurance. FAQ Index


2) What is the difference between a 12/12 and a 12/15 Program?
The 12/12 Program requires that all claims be incurred and paid within the 12-month contract period. The 12/15 Program requires that all claims be incurred within the 12-month contract period but paid within 15 months (3 month run-out period). FAQ Index


3) What are the Minimum Annual Premiums?
The Minimum Annual Premium for a 12/12 case is $1,500. The Minimum annual Premium for a 12/15 case is $3,000. FAQ Index


4) When is the Premium due?
At least 95% of the Estimated Annual Premium must be submitted with the signed Preliminary Application. Prior to the Anniversary Date, we will request the “balance” of the earned premium. For Stop Loss cases with Premiums in excess of $50,000, we will consider an alternative payment arrangement. FAQ Index


5) How small of a group can be underwritten?
We do not have a minimum group size, but many States restrict Stop Loss Insurance to groups with 50 or more employees. Also, due to Minimum Annual Premium Requirements a prospect with less than 50 Employees can be a difficult sell. FAQ Index


6) What is the Minimum Annual Aggregate Attachment Point?
The Minimum Annual Aggregate Attachment Point in general is 125% of anticipated claims. FAQ Index


7) What is the Minimum and Maximum Annual Benefit?
The Minimum Benefit, no matter how small the group, is $25,000. The Maximum Benefit, no matter how large the group, is $1,000,000. The Stop Loss Benefit is typically one-times the Annual Aggregate Attachment Point, subject to the minimum/maximum amounts cited herein. FAQ Index


8) Is Stop Loss coverage offered on all Self Funded Dental and/or Vision Plans?
We typically require a significant contribution by the Employer towards the cost of the program and significant participation by the Employees. We do not customarily offer Stop Loss on Voluntary (Employee pay all) Plans but will consider them on a case by case basis. We may not be able to offer coverage for Dual/Multiple Choice Plans. The Carrier reserves the right to refuse to provide coverage when, in their judgment, an inappropriate level of risk exists or a true Employer/Employee relationship is not present. FAQ Index


9) What does Dual/Multiple Choice mean?
These are arrangements that allow the Employee the option of selecting from a menu of benefit plans. A typical menu would be a Capitated Option (EPO/DHMO), a Preferred Provider Option (PPO), and an Indemnity (any provider) Option. The adverse selection that develops, mainly due to pricing differences between the Options, does not lend itself to Stop Loss underwriting consideration. If your Benefit Design includes a PPO feature, we would need detailed information on this Option in order to consider the account for Stop Loss Insurance. FAQ Index


10) May Vision benefits be offered in addition to the Dental Program?
We also offer Stop Loss Insurance for Vision Benefits on either a freestanding basis or as part of the Dental Plan. We need information on all vision services to be covered plus all other standard underwriting data such as; group size, employer contribution, etc. When Vision is offered in conjunction with a Dental Plan, the Attachment Point reflects both risks. FAQ Index


11) How do I request a Quote?
We will gladly mail, fax or e-mail the “Request for Quote” form to you. You can also click here to visit the web based form which can be downloaded and printed or filled out and submitted on-line. FAQ Index


12) What additional information needs to be provided in order to receive a Quote?
We will need the following information:

1. A copy of the ADA or AAO cost estimates for the DR/DA Plans
2. The Dental and/or Vision Benefit Plan description, including the exclusions and limitations
3. Information on the group’s existing Dental and/or Vision Benefits
4. Existing premium rates, and Plan Anniversary Date for current benefits
5. Current employee census as well as current enrollment data [single/two party/ family]

FAQ Index


13) When is the Stop Loss Insurance confirmed?
A Confirmation of Insurance (Binder) is issued upon receipt of the signed Preliminary Application and at least 95% of the Estimated Annual Premium. FAQ Index


14) When is the Stop Loss Policy issued?
The Stop Loss Insurance Policy is issued after all of the following has been received and reviewed: the signed Preliminary Application, a check in an amount equal to at least 95% of the Estimated Annual Premium, current employee roster, and the Summary Plan Description (SPD) for the plan. FAQ Index


15) Who is responsible for “funding” claims?
The Employer is responsible for “funding” all claims, even for claims in excess of the Attachment Point. The Stop Loss Policy will “reimburse” the Employer at the conclusion of the contract period for claims “incurred and paid” during the contract period that are in excess of the Attachment Point. Reimbursement is made after receipt and review of paid claims data to verify incurred/paid dates and plan maximum limits. In an extreme situation, we may require a claims audit prior to paying the Stop Loss reimbursement. We do not offer a Monthly Accommodation arrangement. FAQ Index


16) Are Claims and enrollment data required after the Stop Loss Policy is in place?
We require the TPA to provide MONTHLY enrollment and paid claims data and we will provide the TPA with the appropriate Monthly Claims Reporting Form. The monthly reporting of enrollment/paid claims data is required by the Carrier and is utilized in computing the Renewal Attachment factors. FAQ Index


17) What happens if the Employee Enrollment changes?
In those instances where the Employee population changes dramatically during the course of the policy period we may advise the TPA that the case requires additional premium. Any additional premium required is due within 30 days of said notification. FAQ Index


18) Is the TPA paid by Dentafits?
In consideration of the TPA providing all of the above reports, we customarily pay the TPA an “Administrative Allowance”. For Stop Loss cases where premiums are in excess of $50,000, the Administrative Allowance is negotiated. FAQ Index

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