Why Health Plans and Employers Need Stop Loss Reporting

Due to the ongoing rise of healthcare costs, many employers with self-insured health plans often purchase stop loss coverage in order to protect themselves against catastrophic or unpredictable losses associated with high-cost claimants. This coverage is not medical insurance; but rather, it’s a financial and risk management tool that protects the employer from excessive claims.

Stop loss is used in two ways:

  • “Specific stop loss” is used by health plans to cap the limit on claim liability for any covered member. The stop loss insurance coverage reimburses the employer if any participant’s claims exceed a specified per-individual deductible amount.
  • Under “aggregate stop loss,” employers are protected from costs that exceed a threshold for the entire group of plan participants. All participant claims under the specific deductible are combined in one “pool.” When the total of these claims reaches a set dollar amount, the stop loss carrier begins to pay claims

One Stop for Stop Loss

Timely reporting to employers on incurred medical expenses and utilization, as it relates to their stop loss coverage, is critical. At MedeAnalytics, we offer advanced Stop Loss Reporting as an optional module within the Employer Reporting product. Health plans can quickly identify high cost claimants and members with trigger diagnoses, which are those diagnoses likely to lead to high cost claimant status. Health plans also gain the insights they need to implement preventive health programs or devise other strategies to help mitigate expenses.

This module helps employers:

  • Manage high-cost claimants and provide a complete picture of their cost and use of healthcare services in a secure, cloud-based solution integrated with health plan benefits
  • Eliminate manual processing to save time and resources
  • Automate reporting for carved out stop loss policies purchased from a third party and products purchased from the employer’s health plan
  • Ensure data security standards by using robust role-based security to display only relevant data to each employer.

The MedeAnalytics solution is integrated with health plan benefits and provides employers with a complete picture of their cost and utilization of healthcare services.

Interested in learning about our other Employer Reporting solutions? Visit our Payer Solutions page.

MedeAnalytics

MedeAnalytics is a leader in healthcare analytics, providing innovative solutions that enable measurable impact for healthcare payers and providers. With the most advanced data orchestration in healthcare, payers and providers count on us to deliver actionable insights that improve financial, operational, and clinical outcomes. To date, we’ve helped uncover millions of dollars in savings annually.

Get our take on industry trends

Data Science into your Organization part 3

Crawl: Bringing Data Science into your Organization

August 16, 2021

Throughout my career as a data scientist, I’ve been lucky enough to have a few opportunities to build data science…

Read on...
How Ballad Health achieved enterprise-wide strategy alignment

Success Story: How Ballard Health achieved enterprise-wide strategy alignment

July 26, 2021

A key to success for any organization is finding a way to unite departments and individuals around common objectives and…

Read on...
data dashboards photo

Tell the best healthcare story with data dashboards

July 20, 2021

By this point, we’ve all heard the statistic that healthcare data is growing at 36% annually. The result of this…

Read on...
Large Midwest health plan maximizes employer client value with improved analysis and reporting

Success Story: Large Midwest health plan maximizes employer client value with improved analysis and reporting

July 16, 2021

A unique requirement of running a successful health plan is staying current on the needs, trends and metrics of employers…

Read on...