Stop Loss Edge: Self-funding and rewards in one innovative program

More small- and mid-market employers are choosing self-funding than ever before,¹ but employers of this size can inherently experience greater volatility than larger companies, making it difficult to choose self-funding despite the potential benefits: cost savings and added control over benefits design.

That’s why we created the innovative Stop Loss Edge program. Our goal is to provide a new pathway for mid-market health plan sponsors who are ready to go from a fully insured health plan to a self-funded one and do so with confidence.

With Edge, employers with 100+ to 500 employees² in their health plan can take advantage of self-funding coverage via a pooled approach to renewals and rewards. The program is designed to offer opportunities for long-term stability and access to rewards for profitability of both group and pool results.

Two opportunities for rewards

Program-level Rewards

Up to 5% of premiums refunded if full program runs below 70% loss ratio*
 

Group-level Rewards

Up to an additional 5% of premiums refunded to individual groups that run below 70% loss ratio*

*25% of profit below 70% net loss ratio, renewal required.

Self-funding with more long-term stability

Many self-funded employers will likely experience a challenging plan year at some point. Edge includes common-sense features like a rate cap and no new laser guarantee, along with accelerated reimbursement options that are intended to speed up reimbursements — to help enable employers to self-fund their health plans when they otherwise may need to consider the potential of returning to a fully insured plan.

Additional Edge program benefits for employers:

• Effective date options: Employers may join on the effective date of their choice, then utilize one of the Edge program’s pooled renewal dates (1/1, 4/1, 7/1 or 10/1) to facilitate the benefits of pooling and expedite potential financial rewards.
• Enhanced underwriting capabilities: Enables insights when communicating initial quote decisions and firm offers 90 days prior to the effective date.
• Credit for specialty drug enhancement and cost containment: Each client is considered for discounts related to the administrator, network, PBM, and specialty vendor selections they are utilizing or considering.
• Lower deductibles: Groups may be considered for as low as a $25,000 Individual Excess Risk deductible.

Voya innovation in action

In every area of interaction with our customers, we strive to simplify, integrate and optimize the experience to save time and improve outcomes. Our Stop Loss Edge program gives more plan sponsors considering self-funding access to our claims processes and contract features — and supported by the financial strength of the insurance companies³.

To learn more about Stop Loss Insurance and the Stop Loss Edge program, contact your Voya representative today.