Adam's Advantage videos
Here is a collection of videos that feature key topics and information.
Definitely check them out, and feel free to share the resources with your colleagues.
Adam's Advantage
Hello and welcome to Adam's Advantage
For those who do not know me, my name is Adam Noce and I have been selling Medical Stop-Loss with Sun Life Employee Benefits since 2004. I work with Benefit Consultants in the Eastern Pennsylvania Territory, which includes a little bit of Southern New Jersey. I currently reside in West Chester, Pennsylvania with my wife, two daughters, 3 dogs and 1 cat. I’m originally from a small town called Hooksett, New Hampshire and graduated from Bentley University in 2002. My hobbies include Surfing, Playing Corn Hole, Attending Live Music Events with my wife (We mainly enjoy Country, but we like all types of music) watching Professional Sports, and spending time at the “Jersey Shore” during the Summer.
Gene Therapies NNL Enhancement
amazing topics to explore
Meet Adam
Specific advance option
Gene Therapies whitepaper
Accelerated ASO Reimbursement
IBC & Sun Life value story
Health Navigator alongside Stop-Loss
Cancer
rider
2024
2023
Thought leadership and resources available to you!
Digital experiences
February 2023: Packaged Supplemental Health with Stop-Loss
• 3% off Stop-Loss rates if a group adds 2 Supplemental Health Coverages and Basic Life, Dental (Fully Insured), or Long Term Disability
• 2% off Stop-Loss rates if a group adds 2 Supplemental Health Coverages
• 2% off Stop-Loss Rates if a group adds Basic Life, Dental (Fully Insured), or Long Term Disability.
• 1% off Stop-Loss rates if you already have Basic Life, Dental (Fully Insured), or Long Term Disability and add 2 supplemental health coverages.
• 1% off Stop- Loss rates if you already have 2 Supplemental Health Coverages and add Basic Life, Dental (Fully Insured) or Long Term Disability.
• Groups receive Step Down Deductibles for ICD-10 Cancer Related Claims when Groups have Sun Life Critical Illness with Cancer option or Sun Life Cancer Policy
• Step Down Deductibles can be up to $10,000
• Cancer Claims are our number 1 reimbursed claim
• Claimant does NOT need to elect Critical Illness or Cancer Policy for employer to receive Step-Down Deductible.
• Stop Loss Cross Program Discounts apply to inforce Stop-loss cases only
March 2023 - Let's talk about Health Navigator!
• Health Navigator will gather Client medical records securely, offer 2nd opinion services if necessary, then get Clients the appointments with the best physicians within that specialty.
• The goal of Health Navigator is to make sure Clients have the right diagnosis, the right treatment, and the most efficient access to the best care.
• Heath Navigator has access to over 130 medical facilities nationally.
• If Health Navigator is inforce with Stop-loss. If a claimant breaches the specific deductible, utilizes Health Navigator with a qualifying event, the employer will receive a step down deductible that is 10% of the specific deductible to a max of $25,000
• If Heath Navigator is included with Sun Life Stop-Loss, we will discount the Aggregate Deductible Factors 3% at point of sale or renewal. If added mid-year, we’ll decrease the Aggregated Deductible factors at renewal.
• Health Navigator is a “First Class Health Care Concierge Service"
• Health Navigator is there to help guide Clients through the complicated health care maze
• Health Navigator's main purpose:
o To provide health advocacy and care navigation
o To empower Clients to confidentially make decisions
o Remove access barriers
o Provide a highly personalized touch
Video Highlights
Feel free to look around and if you have any questions, please feel free to contact me at adam.noce@sunlife.com
Thanks again for stopping by and I hope these videos and marketing pieces help you gain the “Advantage”.
I work jointly with Benefit Consultants to come up with Self-Funded Medical Stop-Loss Solutions for their clients. My main mission is to be a “RESOURCE” for you and your clients. At Sun Life Employee Benefits, we do more than just provide quotes. At Sun Life we provide Education and Resources to help you with your consultative services. Therefore, I introduce to you, “Adam’s Advantage”! Each Month I will create a video of one of my Sun Life “Key Advantages.” We’ll be covering a wide array of different Stop-Loss Advantages and I really hope you enjoy it. I have also included some great marketing pieces below.
• Sun Life's stop-loss projected claims calculator helps show incidence levels based on the size of the group and deductible
• The data is accumulated through our $2.4 Billion Book of Business plus through data RFP’s we received
• This is based on actuarial data within Sun Life Employee Benefits
• This is a great tool to determine which deductible is best for you
Video Highlights
April 2023 - Choosing the Right Deductible
Click here to view our calculator and find the right deductible level for you!
You can also find the calculator under “Digital Experiences” on the Adam’s Advantage Website!
Video Highlights
Featured content: 12th annual high-cost claims and injectable drug trends report
For the past twelve years, Sun Life has actively analyzed our claims data with a goal of helping self-funded employers better understand the trends and potential impacts of high-cost medical and injectable drug claims. Every year, we commit to sharing these insights so employers can make well-informed risk management decisions that benefit their employees and their business. Our 12th annual research report provides updated rankings of the top 20 high-cost claim conditions and their continued rise.
Link to the full report
HCCR Webinar Recording
Top conditions by size and industry
Top 50 injectable drugs deep dive
• 71% of all stop-loss Claims came from the top 10 claim conditions.
• While cancer continues to be the largest driver of high cost claims, cardiovascular disease rose one spot to the number 2 claim condition in 2022 with over $142 million in reimbursements for over 2,300 members
• 11 of the top 20 high cost injectable drugs are related to cancer
• Rylaze, the cancer drug with the highest average cost ($808.7K), is new to the top 20 injectables drug list this year.
Highlights and key statistics from the Report:
May 2023 - The 11th high-cost claims and injectable drug trends analysis!
Click here to explore more!
Clinical 360 overview
• Approximately 1 in 9 employers (11%) experienced a birth-related stop-loss claim in the 4 year benefit period from 2018-2022. The Average costs is $371.8K. One of the highest average costs for claims.
• 20% of employers had at least 1 member with over $1M in claims during a year period from 2018-2022
• Million Dollar claims on a per million covered employees basis rose 15% in the past year and 45% over the past 4 years.
The White Paper covers the following:
• What is a Gene Therapy
• How do they work?
• What types of conditions do they help with?
• What is the FDA Approval Process
• How do Gene and Cell Therapies Differ?
• What is Roctavian and Hegenix and how do they help with Hemophilia
The Gene Therapy White Paper is a GREAT tool for you and your clients to understand how gene therapies work and could affect your medical plan.
Click here for the report!
June 2023 - The Gene Therapy White Paper!
• Specific advance option
• Reduced administrative fees
• Waived disclosure requirements
• Streamlined claims process and improved access to claims data
• Plan document acceptance
Interested in what our partnership has to offer?
Click here learn more!
July 2023 - Sun Life's NEW IBC Partnership
Did you hear? Sun Life has a new partnership offering with Independence Blue Cross!
Key Features of the New Sun Life and IBC Partnership:
To Request your Sun Life Stop-Loss Renewal for the 4th quarter, please send the following to adam.noce@sunlife.com:
Are you ready to renew with Sun Life?
August 2023 - It's renewal time! Get excited!!
For Specific Coverage:
o Individual large claims that are 50% of the Spec Deductible with diagnosis from (1/1/22-12/31/22 and 1/1/23-8/31/23)
o If RX is carved out, we will need RX claims over $10K from 1/1/22-12/31/22 and 1/1/23-8/31/23)
• Any Plan design changes
• Please note that depending on the risk we can firm up 1/1/24 cases with claims through August
• From a New business side, we can also firm up 1/1/24 cases with claims through August.
For Aggregate Coverage:
o Monthly medical and rx claims with monthly enrollment from 1/1/22-12/31/22 and 1/1/23-8/31/23)
• Census: Name, Date of Birth, Gender, Zip Code, Singe/Family Status, Which medical plan they are in, and Retiree if status if covered
You can also request a renewal benchmark or pre-renewal executive summary!
• 120 Day Sign Off: Claims through August
• 90 Day Sign Off: Claims through September
• 60 Day Sign Off: Claims through October
• 30 Day Sign Off: Claims through November
Sign Off Cheat Sheet for 1/1/24 cases:
As we enter the early stages of 4th quarter, it’s a great time to start thinking about firming up our new business quotes and renewals. The advantages of firming up groups with 120 and 90 day sign offs enables you to lock into your 1/1/24 rate early and to avoid a potential risk adjustment on your renewal as claims start to increase towards the end of the policy period. Please keep in mind that early sign offs do have deadlines. Please pay attention to those.
Let's chat and work together to firm up cases!
Request a renewal benchmark from us today!
September 2023 - Time to Firm Up our Quotes and Renewals!!
Please note that earlier sign offs can carry an additional rate load depending on the risk of the group.
• There is a slight load for this feature
• Refunds are paid 6 month arrears after the contract basis is complete
• A group must be renew with Sun Life and be inforce to receive the refund.
• Minimum Spec Premium to quote is $500,000
A couple things to remember:
Now as you are firming up your quotes, it’s a great opportunity to get creative and offer your employers with an “Experience Refund” Option. With the Experience Refund, your employers will have an opportunity to receive up to 10% of their Specific Stop-Loss Premium back (excluding commissions) if they have a loss ratio less than 70% (Other thresholds can be quoted). With groups looking to find savings anywhere they can, this feature will reward your clients with good experience.
Experience Refund Option
October 2023 - Experience Refunds
• Come from the group and be sent to the broker consultant. Then the broker consultant can forward it to Sun Life
• State the deductible they are purchasing
• State the Effective date of sale
• Mention what coverages they are purchasing (ie Spec and Agg or Spec Only)
The Benefit Confirmation MUST:
As we approach the end of the year, it can be very difficult to get signed applications to wrap up your 1/1 renewals and new business sales. Most carriers will provide deadlines of when they need decisions and it can be hard to get a signed application by those deadlines. At Sun Life, we have a solution and an “Advantage.” You can lock into your rates via the sold case deadline with a "Benefit Confirmation" email. The Benefit Confirmation Email locks your rates when there is a deadline and can protect you if you do not think that you can get a signed application by 12/31/23.
Happy Thanksgiving!!!
November 2023 - Thanksgiving special, benefits and confirmations
If we quote a group and provide you with a 12/15 deadline. If you cannot provide us a signed application by this deadline to lock into rates, we will accept a “Benefit Confirmation” email. At that point, we can collect the sold case paperwork at a later time. This does not replace the General Applications but protects you if your client is off for an extended period of time and you will not be able to obtain a signed application by the end of the year.
A Benefit Confirmation looks like this:
“Effective 1/1/24, ABC Company will be moving their Stop-Loss to Sun Life at the XX deductible for Specific and Aggregate Coverage.” This email from the group to you will lock your groups into the firm rates quoted.
Watch the video for more!
Merry Christmas, Happy Holidays, and a Happy New Year to you and your families!!
Thank you for an awesome year and looking forward to 2024!
December 2023!!
December
October
September
August
July
June
May
April
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February
January
Hope you all had a happy and foodfilled Thanksgiving!
For November’s Adam Advantage, Lola the Stop-Loss Dog and I talk about the Advantages of “Gap-Less” Renewals.
November 2024: seamless protection with gapless renewals
Check out the above image or watch my video for more information!
Interested in other Sun Life product offerings? Click here!
I want to share a feature that is automatically included for all BUCA ASO administered cases. It’s called “Accelerated Reimbursement.” This feature allows Sun Life to reimburse on large claims prior to receiving the monthly report that is sent to us by the BUCA carrier and is included at no additional cost. As we work on cases together this 4th quarter, some groups could be concerned about unbundling their stop-loss due to the time it will take to receive reimbursements back. With ASO Accelerated Reimbursement, we solve that problem!! We will reimburse a claim within 48 Hours of receiving the required items needed ( Claim number, Provider Name, Date of Service, Paid Amount and Paid Date).
For October’s Adam Advantage:
October 2024: Be in the know about ASO (accelerated reimbursement)
Groups can choose to utilize Rx Standard (free) where claims are sent to us monthly via email. The other way is via Rx plus (slight load), where Rx claims are sent to us via an FTP feed at the first dollar basis. Both options are great for your employers to make sure that they are receiving reimbursements in a timely manner. This also helps with determining spec hits quicker. If you are going to unbundle your Rx, make sure you do it with the pros at Sun Life. Please let me know if you have any questions.
We can do this via 2 different options.
For September’s Adam’s Advantage, I wanted to discuss the importance of choosing the right stop-loss carrier for when your Rx is unbundled. Some Stop Loss carriers will not marry up claims monthly and will wait quarterly or annually. This can be a problem for cash flow and turnaround times. At Sun Life, we provide a solution to you and your employers. Sun Life will marry Medical and Rx claims on monthly basis for faster reimbursements.
September 2024: Is your Rx carved out?
When the class is over, we will open it up with a Q&A session and then we’ll raffle off some great items, including a “Brand New Blackstone 22’’ Table Top Griddle with Hood.” This griddle is great for camping, tailgating, or even your backyard. It has 2 burner and will be perfect for the Fall!! To register for the event, please RSVP via above on the "Yes" link, the email invite, or email me directly at adam.noce@sunlife.com. Hope to see you there! Please feel free to share the invite within your office.
Sun Life and Independence Blue Cross will be hosting a Continuing Education Credit event on October 1st at Blue Bell Country Club. The event starts with a Hot Breakfast buffet at 8:30 AM, where you will be able to mingle and enjoy breakfast with your colleagues. Then starting at 9:15 AM, there will be a 1 hour Continuing Education class covering Sun Life’s 2024 Catastrophic Claims and Injectable Drug Research Report. The class will provide you with 1 CE credit and the information is very valuable to you and your clients. This by far our most popular CE course. We will be talking about trends within the top 20 conditions, the increase of claims over $1M, trends in RX drugs costs, new RX drugs entering the top 20 list, and much more.
Who needs CE credits?
August 2024: Sun Life and IBX CE Class October 1st!!
Here is your cheat sheet to what we will need to complete your 1/1/25 Stop-Loss Renewal:
• Census (Name, DOB, Gender, Zip Code, Single/Family Tier, Medical Plan, Active/Retiree status)
• Individual large claims with diagnosis for claimants that are 50% or more of the deductible with diagnosis with reporting dates, 1/1/23-12/31/23 and 1/1/24-8/31/24. If RX is carved out, we need an identifier to match up the Medical and RX claims.
• If Rx is carved out, please send claimants with claims over $5K with reporting dates, 1/1/23-12/31/23 and 1/1/23-8/31/24. Please include names so we can match up to medical.
• Monthly Medical and RX claims with Monthly enrollment from 1/1/23-12/31/23 and 1/1/24-8/31/24
• Any Plan Changes
• We can firm up Stop-Loss Renewals with claims through September. However, depending on the risk of the group, we may be able to firm up with claims through August.
• Early Renewals are typically more conservative. So if you are looking for a 1/1/25 renewal with claims through July, the rates will be conservative, because the proposal would be considered very illustrative. The completion period is not even 50% at this point.
• All information can be either sent to me or the stop-loss renewal mailbox at stoplossrenewals@sunlife.com
Typically within the next couple weeks, I get asked, “Is my renewal ready?" This video is a reminder that Stop-Loss Renewals are “NOT” automatically completed. We do require that updated census and claim information are sent directly to Sun Life.
It’s almost that time of year. 1/1/25 Stop-Loss season!
Watch my video for more info and request a renewal benchmark too!
July 2024: Is My Renewal Ready?
For June, I wanted to make a video about being “Prepared for the Unexpected.” For this month’s video, I talk about an experience some friends were sharing with my wife and I regarding how a family’s life was turned upside down, when a family member received news about a serious medical condition. It sounded super stressful and scary. Your life goes from 0 to 60 in seconds and everything around you is consumed by this serious medical condition. I imagine what our mutual customers go through. Just look at our high-cost claims report. Each person on that report is dealing with a condition that has taken over their lives and it can be stressful. All of sudden your life is full of questions. Is this the correct diagnosis? How will I get appointments? Where can I find the “BEST” doctors?” How can I become more informed, an expert in this diagnosis? That’s where Sun Life Employee Benefits and Health Navigator step in. Health Navigator is a product that we sell, where claimants and their families will have access to first-class concierge services. It’s there to support members through all of these extremely stressful and scary situations. Guidance and help is the first thing they look for. Health Navigator accomplishes this.
Prepare for the Unexpected with Health Navigator
Click on the images to learn more!
June: Health and care support with Health Navigator
For the past twelve years, Sun Life has actively analyzed our claims
data with a goal of helping self-funded employers better understand
the trends and potential impacts of high-cost medical and injectable
drug claims. Every year, we commit to sharing these insights so
employers can make well-informed risk management decisions that
benefit their employees and their business.
The Brand New 2024 Catastrophic Claims Report is now available!!!!
Click here to read, download, or share the report!
May 2024: High-cost claims report!
For the month of April, we are going to talk about the brand new Sun Life “Enhanced No New Laser with Gene Therapy Protection” feature that becomes effective 7/1/24. As Gene Therapies receive FDA approval, and their prices continue to rise, providing coverage for these cutting-edge treatments poses a major challenge for Self-funded Employers. At Sun Life, we have enhanced our No New Laser policies to help with this. Effective 7/1/24, policies both new and existing will automatically receive the enhanced coverage. This applies to all current and future FDA-approved Gene Therapies. With this update, Sun Life enables employers to say yes to the latest medical advancements and no to unsustainable cost increases.
• All FDA-Approved Gene Therapies covered
• No Lasers can be set for costs associated with Gene Therapies!!
• No separate Gene Therapy deductible
• No Pre-existing conditions restrictions
• Mitigates impact at renewal for Gene Therapies.
Video highlights
April: New Enhanced No New Laser and Gene Therapy Protection
Hi Everyone! For March’s Adam’s Advantage, the Ides of March of came through and my “Record Screen” feature on my recording app was not working, so I am going to do a little bit of a fun video instead. The Screen Recorder feature enables me to show features that I am looking at when you log into “Adam’s Advantage.” When I try to share information, I like to show visuals, so I am mixing it up this month with a fun video. I know that some of you have seen this video already, but I figure I’d tell the story behind it and how I went viral this Summer at the Exton Walmart. Next month I’ll make it more educational as I will receive all the recording features I need.
Video Highlights
March: Talk about madness - internet fame and tech issues!
“Warning:” There is some slight profanity but not in a negative way. Enjoy!! I get approached on this all of the time. It’s up to 6.6M views and 494K likes. Cameras are everywhere!! Check it out by clicking on the phone!
• This rider is included on all Stop-Loss Polices for no load. (Groups just need to have the Sun Life Critical Illness and Accident policy in place for it to turn on)
• Clients that offer Stop-Loss and two of our Supplemental Health Coverages could be eligible for a Stop-Loss Rate reduction of up to 3%.
• If you would like to quote Critical Illness, and Accident with the Cancer option, please reach out to your Sun Life Employee Benefits Representative
o $0-$50,000: $1,250
o $50,001- $100,000: $2,500
o $100,001-$200,000: $5,000
o $200,001-$300,000: $7,500
o $300,001- higher: $10,000
This month’s video explains the key advantages of including a Sun Life Critical Illness and Accident Policy with the Cancer Rider when you have Sun Life Stop-Loss in place!!
Video Highlights
February 2024: Learn about Sun Life's stop-loss Cancer Rider!
January 2024: Understanding your stop-loss policy
We had a successful 2023 and we thank you all so much for your partnerships. For the first Adam’s Advantage of 2024, I am covering one of our super helpful digital experiences. It’s called “Understanding your Stop Loss Policy.” With 1/1 effective dates behind us, it’s time for your clients to receive their Stop-Loss Contracts. Included with the contracts is the “Understanding your Stop-Loss Policy” Digital Experience. This feature is fantastic. It provides you and your customer with explanations and definitions that are easier to understand. This is also a great feature for if you are ever looking for a sample contract!!! To access the digital experience, you can click on this link or click on the image!
Happy New Year Everyone!!
I want to Thank you all again for everything. I am very grateful to be partnering with brokers and consultants like yourselves. I look forward to a successful 2024.
If there is anything I can do to help you achieve your client goals, please feel free to reach out.
• Groups that have a Sun Life Stop-Loss Policy and a Sun Life sponsored Critical Illness Accident policy with the Cancer Rider, will receive a Step Down Deductible for any claims that are ICD-10 Cancer related:
Check out our cancer rider flyer for more information!
Watch my video and click on the flyer to learn more!
This report contains claims data from 2020 through 2023 for nearly
60,000 members with claims. The data represents over $6.1B in total
reimbursements and nearly $13.5B in total cost. This comprehensive
data set encompasses the full book of business for Sun Life Stop-Loss
Watch my video for more key info!!
If you have any questions, please feel free to contact me!
Click the "Yes" to RSVP!
Watch my video to learn more!
This is a big advantage, opposed to waiting for the monthly report to be sent to the Stop-Loss Carrier. Although, it's mostly used for claims over $100K, we can accommodate lower thresholds if needed. Accelerated Reimbursement puts clients at ease, so they can unbundle their stop-loss and still receive large reimbursements in a timely manner. If you have any questions, please feel free to contact me.
This feature is available only to policyholders that have a Specific Stop-Loss contract with a “Run-Out” contract basis. Run Out contracts are beneficial because they provide coverage for claims incurred during the policy period but paid during the run-out period. At risk, however, are claims incurred during the policy year but paid after the run-out period, which can result in a large claim being ineligible under the Stop-Loss policy. With Sun Life “Gap-Less” renewals, any eligible expense incurred after the original effective date of the Sun Life policy but paid after the run-out period is eligible under the subsequent renewal policy year and is reimbursed once the renewal policy deductible is met.
Some things to note:
• The group must renew for the feature to work
• If a 2024 incurred Gap-Less claim for example, is paid in 2025 past the run out, any 2025 incurred claim for that claimant still needs to re-satisfy the deductible for 2025 renewal deductible. A previous period Gap-Less renewal claim does not satisfy the new policy period’s deductible.
• Included at no cost
• A good tool to use to combat 12/24 contracts (quote a 12/15 or 12/18 with the Sun Life Gap-less renewal feature)
Watch my video or click here to learn more!
November
Happy Holidays!!
I would like to wish you and your family a Happy Holiday Season!!! Thank you for your partnership and I hope you enjoyed the Adam’s Advantage Videos Series for 2024.
I am looking forward to making move videos in 2025 and I’m also looking forward to working with you all in 2025!! I enjoy working with each and every one of you. If there is anything you need, please do not hesitate to reach out. Happy Holidays and Happy New Year!!
December 2024: Happy Holidays from Sun Life!
Watch my video to learn more!
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2025
December
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october
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amazing topics to explore
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amazing topics to explore
2023
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The employer receives the benefit, even if the Cancer claimant did not sign up for Critical Illness. This is a great opportunity for your customers to get more out of their Stop-Loss Policies with Sun Life. Here is the breakdown of payout.
Happy January! Thank you again for all of your help in 2024. I look forward to working with you all in 2025.
I also look forward to making more Adam’s Advantage Videos.
For the month of January, I am covering the Sun Life Cancer Rider that is automatically included with all Stop-Loss Policies at no additional cost. The feature turns on when an employer puts in place a Sun Life Sponsored Critical Illness with Cancer/Accident Policy inforce. When a group does this and has a Sun Life Stop-Loss policy inforce, the Stop-Loss Cancer Rider will turn on automatically!! With the Cancer Rider, if a group has an ICD-10 Code cancer claim, the group will receive step-down deductible (additional benefit essentially) based on what deductible they have. Cancer Rider claims are filed automatically and do not go towards your claims experience.
January 2025: Sun Life Cancer Rider
Watch my video or click here (our amazing cancer rider flyer) to learn more!
Deductible Payout
$0-$50K $1,250
$50.1K-$100K $2,500
$100.1K-$200K $5,000
$200.1K-$300K $7,500
$300.1K-up $10,000
This digital experience is a great resource to have at your disposal. When groups go self-funded for the first time, they have a lot of questions, and they want to make sure that their risk is protected. This Digital Experience will help provide you with the resources you need to help your clients make the best financial decisions.
Hi everyone! For February’s Adam’s Advantage, I wanted to highlight one of the “Digital Experiences” that is located on my “Adam’s Advantage” website.
This month’s video walks you through the “Using Data to Create a Successful Stop-Loss Plan” digital experience. This digital experience is helpful for groups looking to self-fund for the first time. It has a lot of great data that will help you and your clients understand what coverage types make the most sense. It helps with understanding and selecting deductible levels, high costs conditions they will face based on industry and size, information on high costs injectable drugs, and Stop-Loss Product features.
February 2025: Using Data to Create a Successful Stop-Loss Plan
Check out our Self-Funded Playbook or reach out to me to learn more about self-funding!
