Stop Loss Insurance

We’ve been providing Stop Loss solutions to self-funded employers since 1975. Our experience and service in this market has provided a guiding hand for 50 years — all while maintaining a pulse on the market and emerging trends.

Stop Loss Insurance: We’ve got you covered

We can help self-funded employers manage the risk of high-cost medical claims and minimize the financial impact of those claims on their assets. As a dedicated direct writer of Stop Loss, we’ve got you covered. Employers can work with us to craft a strategy that’s flexible — and choose the options that meet their specific needs and employee population.

Steadfast protection that weathers any storm

Our Stop Loss Insurance helps self-funded employers lessen the impact of devastating medical claims through flexible contracts, customizable plans and a consultative, client-focused approach.

We support self-funded groups down to 100¹ lives and individual deductibles down to $25,000 — to help keep costs in check and predictable for employers and their employees. Many of our Stop Loss features are standard including plan mirroring, individual advanced funding and ASO expedited reimbursement.

Among the top 3 direct writers of Stop Loss in the U.S.²

Whether you’re carving out Stop Loss for the first time or you’re an experienced client looking for cost containment solutions, we can help. We’ll be by your side every step of the way.

Flexibility – Whether you’re incorporating PPO networks, reference-based pricing plans, hybrid plans, direct contracts, carve-outs for certain treatments or conditions, or other custom solutions, we are here to help.
Streamlined claims process – Along with a premier claims team, employers receive individual advanced funding or ASO expedited reimbursement, which is standard, and optional monthly accommodation for aggregate coverage is available.
Cost Containment programs – We can assist with managing claims costs, as our experienced team will help connect employers to premier networks and vendors for needs such as transplant or cancer care. We may also provide additional credit and coverage for point solutions and pharmacy solutions an employer implements.

Choose between two approaches to Stop Loss: unbundled or bundled

Unbundled or carved-out Stop Loss allows you to choose the optimal vendors with the goal of finding the greatest cost savings and benefits for your specific plan. We can lock in quotes with nine months of complete claims information for the current policy year and build a multi-year plan intended to help keep your costs down and your employees covered.

Choosing the unbundled approach may also lead to improved Stop Loss terms and conditions. More advantages to unbundling include:

Greater flexibility – Employers can select a Stop Loss policy that best fits their needs without being tied to the administrator’s offerings
Potential cost savings – Employers can select the most cost-effective Stop Loss policy and administration services separately, which can help to encourage savings
A second set of eyes – We can help employers look at and “audit” their highest dollar catastrophic claims

How employers benefit from an unbundled plan:

Cost Containment programs⁷ to help mitigate costs and maximize savings

Our team of clinicians strive to achieve savings for our clients with large case management assistance, while providing a seamless experience to members. Employers can get help managing high-dollar conditions from transplants, high risk pregnancy and burns or multiple trauma — to blood clotting drugs, hospitalizations lasting seven or more days, and more.

Auditing high-dollar claims
Reviewing high-cost diagnoses, drugs, therapies and precertification/large case management notifications for possible intervention
Proactively monitoring industry trends and new treatments

How we can help you and your employees

Vendors and programs

Our dedicated Cost Containment team will ensure employers are connected to the resources they need. All of our Cost Containment programs are included with our Stop Loss coverage, voluntary on a case-by-case basis and include:

Competitive vendor fees that are a fixed percentage of savings
Vendor fees reimbursed to clients within the applicable Stop Loss claim
An experienced Cost Containment team to meet your individual needs

Program details

Transplant networks: We have agreements with multiple leading transplant networks and national centers of excellence networks — and offer extra-contractual negotiations for out-of-network facilities. Access to these networks and services can help reduce an employer’s financial risk.
Specialty pharmacy: Specialty pharmaceuticals can be costly. This program through our third-party vendor is focused on clinical and bill review and claim negotiations for complex and chronic conditions requiring specialty, biotech, infusions and other medical products. A pharmacist is available to review and negotiate these specialty needs.
Cell and gene therapy management: We work with our third-party vendors to offer solutions that help payers manage the immense cost, high-risk and intricate processes associated with treating rare, complex and costly medical conditions.
Renal and dialysis management: The treatment of chronic kidney disease, renal dialysis and end-stage renal disease can drive some of the highest costs for self-funded medical plans.⁸ Our third-party vendor offers an extensive network of 3,000 outpatient dialysis facilities — and provided itemized bill review and negotiations for out-of-network facilities. Significant discounts on dialysis, medications and dialysis related services — coupled with coordinated care — helps control costs and enhance overall patient care.⁹
Claim review and negotiation: Through our third-party vendors, we provide bill review, negotiation and documentation of settlement for both in-network and out-of-network claims. Our highly experienced claim negotiation vendors determine what amounts are within industry standards and where negotiation would be most effective. Once the claim negotiators have come to an agreement, a contractually binding discount settlement is signed by the provider to eliminate disputes and/or balance billing to the patient or employer group.
Cancer treatment: We have multiple options to help cost contain high-cost cancer claims. We offer access to premier network rates at nationally recognized facilities and our vendors offer discounts with Cancer Treatment Centers of America (CTCA).

Cancer Treatment Centers of America (CTCA) are not affiliated with the Voya® family of companies.

We’re always looking for ways to leverage innovation to help self-funded employers. Here are two of our latest solutions — with more in development:

Stop Loss Edge

Stop Loss Edge is an innovative way to take advantage of self-funded health plan coverage, offering a pooled approach to renewals and rewards. Designed for mid-market plan sponsors with 100¹ to 500 employees, it offers opportunities for long-term stability and access to rewards for profitability of both group and pool results.

Eligibility Fast Pass

Eligibility Fast Pass is a process that allows us to utilize basic eligibility information provided via a “preferred census” to review initial claims. This service is available for all employers with our Stop Loss coverage. When used in conjunction with the regularly required census, the additional “preferred census” data points enable us to review most claims without pending the initial claim, sending a request for eligibility and awaiting the information to be provided.¹⁰

Whose claims can be covered?

Employee
Spouse
Dependent
Retirees
COBRA participants

Types of coverage

Employers can choose from an array of available features to help their Stop Loss plans work for them.

1. Individual Excess Risk

Protects the plan by reimbursing plan sponsors for eligible claims paid over the individual deductible amount for any covered individual:

Includes coverage for medical and prescription drug claims
Flexible deductible levels to meet a wide range of budgets

Available features

Laser free renewal:^3,4 As an added layer of protection against risk and catastrophic claims, employers may choose to guarantee no new lasers on their renewals.
Renewal rate cap:⁴ We can help make an employer’s renewal with us more predictable by including a renewal rate cap in the policy. When an employer renews their contract, the increase in premium will not exceed an agreed upon percentage.
Individual Gapless renewal: When a 12/15 or 12/18 run-out contract renews with us, this provision allows protection for claims incurred within the expired contract period by creating a six-month extension of the run-out period. Claims will be applied toward the individual deductible of the renewed contract period.
Plan mirroring coordination:⁴ Our flexible plan mirroring option can be structured to match an employer’s plan coverage. This means we will reimburse the eligible expenses covered by an employer’s benefit plan.
Individual advanced funding:⁵ Qualified groups may receive reimbursement earlier with individual advanced funding. We help employers manage their cash flow by quickly reimbursing for eligible individual claims that exceed the individual deductible.
ASO expedited reimbursement:⁵ For employers with an ASO, we help to reduce the financial burden of incurring a catastrophic claim by expediting reimbursement of eligible individual claims that exceed the individual deductible.
Step-down deductible:⁴ We know that catastrophic claims come in more than one form. We can help employers manage cancer, kidney failure or transplant claims with a reduced deductible.
Individual terminal liability: Help prevent gaps in coverage by choosing to extend your coverage to include eligible individual expenses incurred within the contract period and paid within three-six months after the contract period ends.

2. Aggregate Excess Risk

Protects the plan by limiting liability to a specific dollar amount for the whole group. This provides the employer with reimbursement for any eligible claims that exceed a specific percentage of the expected claims. When selected, covered claims/expenses paid by the plan are added up (up to the individual stop loss deductible for each person) and the plan is reimbursed if this liability exceeds the aggregate deductible.

Coverage for medical and prescription drug claims
Flexible aggregate attachment point levels to meet a wide range of budgets
Industry leading 85% minimum aggregate deductible

Available features

Aggregate terminal liability: Help prevent gaps in coverage by choosing to extend your coverage to include eligible aggregate expenses incurred within the contract period and paid within three-six months after the contract period ends.

Monthly Aggregate Reimbursement: Submit a request for reimbursement during the policy year when eligible Aggregate expenses exceeds the greater of the minimum or actual calculated year-to-date Aggregate Excess Risk deductible, rather than waiting until the end of the policy year.⁶

Stop Loss stats

Million

Average annual savings 2020-2024¹¹

Days

Average time from receipt to claim determination¹²

Top 3 factors: Why brokers choose Voya¹³

Ease of doing business

Pricing

Responsiveness

Ready to take the next step?

Connect with us today to learn more about our Stop Loss Insurance solutions or contact your broker or Voya representative.

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150 enrolled employee minimum for policies issued in CA, CO, CT, NY or VT
Ranking of top Stop Loss providers in the United States based on 2023 annual premium as of 7/24/2024 by MyHealthGuide Newsletter: News for the Self-Funded Community, and does not include managed health care providers. The Stop-loss Premium Ranking tables reflect Direct Earned Premium from the “Accident and Health Policy Experience Exhibit” (“Supplemental Pages, Insurance Expense Exhibit” section) of publicly available Statutory Reports filed annually by each insurance carrier. Using this ranking, we have further broken out our status as a “Direct Writer” to reach 3rd in listing. This does not differentiate by RLIC or RLNY.
Individual adjusted deductible
Subject to exclusions and underwriting approval
Certain restrictions apply
Subject to exclusions and underwriting approval
Cost containment services are managed and administered by independent third-party entities not affiliated with Voya Employee Benefits. Voya Employee Benefits, a division of ReliaStar Life Insurance Company and ReliaStar Life Insurance Company of New York, does not warrant, guaranty, or make any representations or warranties whatsoever, express or implied, or assume any liability regarding the use or the results of the cost containment services, including without limitation any financial results, any information transmitted or received, any delay in claims processing or payment, or loss of use of such cost containment services.
“Chronic Kidney Disease: Common, Serious, and Costly.” US Centers for Disease Control and Prevention (CDC), cdc.gov, May 15, 2024.
Based on Voya Financial data for an end-stage renal disease cost containment case – year of savings: 2019; claim example based on actual claims savings realized in the year indicated. This is not a guarantee of future results. Actual results may vary.
Please note, some claims may require additional information that we will reach out for on an as-needed basis. Examples of such information is active at work status, confirmation of premium payment when claimants are on leave, etc. Actual results may vary. Eligibility Fast Pass is not insurance coverage.
Average Cost Containment savings from 2020-2024 was $7,521,622.91; Voya 2024 Savings and Membership Report measuring an average of 20 groups a year. Actual results may vary.
Average turnaround time for Stop Loss claims is 9.6 business days from date of receipt to initial review/determination, based on 94,996 claims processed 1/1/22-12/31/24. Actual results may vary.
Results from 2024 Voya Stop Loss Broker Survey; surveyed 1,460 broker contacts and received 74 responses, 5% response rate, representing 66 employers

Stop Loss Insurance is underwritten by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (New York, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya® family of companies. Voya Employee Benefits is a division of both companies. Stop Loss Policy #RL-SL-POL-2013; in New York Policy #RL-SL-POL-2013-NY. Product availability and specific provisions may vary by state.

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Stop Loss Insurance