Sun Life Broker Education Library
Interested in learning more about our Broker Education series? Click into a topic on the left to see a description of what is in each presentation. Reach out to your stop-loss representative to schedule a meeting today!
Important role that stop-loss plays in self-funding
Employer decision points around stop-loss
Employer decision points - other funding arrangements
Understanding stop-loss product offerings
Using benchmark data to make stop-loss decisions (Case study)
Securing a stop-loss quote
Strategies for improving care and cost outcomes
Medical and RX claims trends (Research Report)
Using data to create a successful stop-loss plan (interactive experience)
Self-funding overview
Interactive experience that combines Sun Life's High-cost claims and injectable drug trends report and benchmarking data together
Sun Life stop-loss leadership and strength:
• Sun Life stop-loss snapshot
• Premium history
Insights and tools:
• Insights and education
o High cost claim trends
o Benchmarking
o Self-funding guidance
• Product snapshot
Using data to create a successful stop-loss plan – interactive experience
• Link to tool that can be clicked into/customized for client/broker needs
o Prevalence of a high-cost claim
o Understanding coverage types
o Selecting deductible levels
o High-cost claims based on deductible levels
o Stop-loss product features
Exploring two approaches to respond to risk and the key benefits of self-funding
What is self-funding?
• How to businesses respond to risk?
o Fully insured
o Self-funded
Key benefits to self-funding
• More flexibility and financial control
• Increased claims data
• Conversion options (captives & level funding overview)
Market insights
• Brokers share clients perspective (top 5 reasons/concerns around self-funding)
• How often are covered workers enrolled in a self-funded plan?
Broker best practices
• Identify the right candidates & start the discussion
• Use financial modeling
• Select the right plans and features
What is stop-loss, what factors impact stop-loss rates, and how you can buy stoploss, including both specific and aggregate options to consider
What is stop-loss insurance?
• Key terms
o Stop Loss insurance, deductible, claim, reimbursement
• How do businesses respond to risk?
o Fully insured; Self-funded with stop loss; Self-funded without stop loss
How does it work?
• Stop loss caps the risk
• Specific stop-loss coverage
o How often do employers buy specific stop-loss coverage?
o How common is a stop loss claim & stop loss deductibles by case size
• Aggregate protection
o How often do employers select aggregate coverage?
o What is an aggregate corridor
o How does aggregate stop loss work?
• How the specific and aggregate deductibles work together
• Specific and aggregate integration example
What funding arrangements exist, who administers claims, options between bundled and unbundled stop-loss solutions
Funding arrangement
• Two approaches to consider: fully insured & self-funded health plan costs
Claims administrators
• Who administers claims? Administrative services only (ASO) vs. third party administrator (TPA)
• Unbundling
• What does the marketplace do?
Key considerations in your stop-loss coverage
• Pharmacy benefits
• Plan language
• Employer factors
• How stop-loss caps the risk
• What to look for in a carrier
Other methods of self-funding
• Captives, level-funding, reference based pricing
*learn more in the next deck!*
Learn more about level funding, captives as a method of switching to self-funding, and what reference-based pricing is and can mean for clients
Level funding
• What is it and how does it work
• To level fund, why or why not & who is a good fit
Captive arrangements
• What is a captive & captive program structure
• Why employers choose captives & who is a good fit
• Questions to ask a potential captive partner
An introduction to reference based pricing (RBP)
• What is reference based pricing & how is a claim repriced
• What is Sun Life seeing & questions to ask
• Who is a good fit for RBP
Provider choices
• Covered workers in a self-funded plan by firm size
• Where can you buy stop-loss?
• Unbundling can be a seamless experience
Comparing stop-loss contracts and features, such as features for cash flow protection, key product features, and other considerations
Contract Types
• Common stop-loss contract types
• Run-in coverage
• Claims timeline for a “rolling” 12/15 contract
• Gapless renewal provision
Stop Loss Features
• Cash flow protection
o ASO reimbursement, Advance funding, Monthly aggregate accommodation
• Product features
o No new laser at renewal, Mirroring, Aggregating specific,
Experience rating refund, Terminal liability (TLO)
• Other considerations
o Disclosure, FIRM, Rate locks, Run-in limits, Rx carve-out, Clinical
360
Follow a case study that demonstrates the importance and value
of benchmarking and the key components of the Sun Life Benchmark Report
Sun Life stop-loss benchmark background
• Sun Life Stop-loss snapshot
• Stop-loss benchmark background & why is benchmarking important
• What do employers want to know? Broker & Employer Voices survey
Benchmarking case study
• Employer profile & potential topics of discussion
• Checklist
• Funding arrangement
• Claims administrator
• Key demographics
• Risk profile
• Specific and aggregate coverage
• Projected number of stop-loss claims
• Likely stop-loss claim conditions
• Stop-loss carrier
How to submit a stop-loss quote, including the analysis and understanding of market factors and case factors that you should be aware of
Two approaches to consider
• Funding arrangement comparison
• Components of a self-funded plan
• Employer factors that affect stop-loss rates
Requesting a stop-loss quote
• Submit request for a quote & supporting data
• Risk assessment process
Case-level factors that affect stop-loss rates
• Demographic impact; Contract type; Network impact; Contract features; Disclosure; What does firm mean?
Market factors that affect stop-loss rates
• Lasers; Members with claims over $1M; Likelihood of stop loss claims; Managing leveraged trend
Timelines
• Key points for New Business quoting
• Life cycle of a Renewal
This course gives an overview of cost containment and explores our Clinical 360 and Health Navigator offerings including case studies and success stories
Overview of cost containment
• Behind every claim is a person facing a health challenge
• Common concerns
Clinical 360
• Our Clinical team
• Clinical 360 overview
• The Clinical 360 process
• Clinical 360 Success Stories
Sun Life Health Navigator, powered by PinnacleCare
• Supporting members in the moments that matter
• Sun Life Health Navigator & what is covered
• Why is this even more important right now?
• Our process
• Member experience timeline
• Health Navigator success stories
• Measures of success
Trends in high-cost claim conditions, million-dollar claims, and injectable drugs and why stop-loss is important
Top 10 high cost claim conditions
• Top Diagnoses; Expected cost range; Ten years of high-cost claims; High- cost conditions by deductible; Stop-loss deductible by case size; Cancer: why it’s the top claim even during a pandemic; Covid-19 claims; Trends in the ‘new normal’; Mental health
Million dollar claim trends & injectable drugs
• Top 20 high cost injectable drugs
• Rise of million dollar+ claims & $3M+ claim analysis
• Legislative update
Importance of Stop-Loss Coverage
• Importance of stop-loss coverage
• Claim costs reimbursed by stop-loss coverage
Recommendations
• Environment, medical & RX, and stop-loss recommendations
FOR PRODUCER USE ONLY.
Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 07-SL REV 7-12. In New York, group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12. Product offerings may not be available in all states and may vary depending on state laws and regulations.
© 2022 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life and the globe symbol are trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us.
GSLCR-10896 SLPC 31406 02/22 (exp. 02/24)
Using data to create a successful stop-loss plan
(interactive experience)
Medical and RX claims trends (Research Report)
Strategies for improving care and cost outcomes
Securing a stop-loss quote:
How stop-loss carriers underwrite risk & set rates
Using benchmark data to make stop-loss decisions
(Case study)
Understanding stop-loss product offerings
Employer decision points:
other funding arrangements
Employer decision points
around stop-loss
Important role that stop-loss
plays in self-funding
Self-funding overview
1. Self-funding overview
2. Important role stop-loss plays in self-funding
6. Other funding arrangments: Captives
8. Using benchmark data: Case study
3. Employer decision points around stop-loss
4. Stop-loss product features
5. Contract types and cash flow options
7. Other funding arrangements: Level funding and Reference-based pricing
9. Rate setting and new business underwriting
10. Renewal underwriting and setting rates
14. Using data to create a successful stop-loss plan
15. High-cost claims and injectable drug trends
(External Presentation)
12. The importance of cost containment and care optimization
13. Strategies for improving care and cost outcomes
11. The importance of care navigation and self-advocacy
Additional resources:
Click here for more Broker Education Resources!
Benchmarking overview
2024 High-cost claims and injectable drug trends analysis
Clinical 360
Description for:
Get an overview of self-funding, the key benefits, employer insights and key decision points.
Self-funding overview
What is stop-loss, what factors impact stop-loss rates, and how you can buy stop-loss, including both specific and aggregate options to consider.
Important role stop-loss plays in self-funding
Learn more about captives, their program structures, why employers choose this funding arrangement, and what Sun Life can do as your captive fronting carrier.
Other funding arrangements- Captives
Explore stop-loss contracts, such as cash flow protection, key features, and other considerations.
Contract types and cash flow options
Learn more about our stop-loss product features, including mirroring, no new lasers, terminal liability (TLO) and more!
Stop-loss product features
What funding arrangements exist, who administers claims, and stop-loss basics, including the options between bundles and unbundled stop-loss solutions.
Employer decision points around stop-loss
Navigating the complex healthcare system can be challenging: Learn how Health Navigator has positively impacted our members and their health outcomes.
The importance of care navigation and health advocacy
Get to know the rate setting and renewal underwriting process in addition to what to expect at your first-year renewal.
Renewal underwriting and setting rates
Review what goes into requesting a stop-loss quote, case level factors that impact rates, and new business underwriting process.
Rate setting and new business underwriting
Review a case study demonstrating the importance and value of benchmarking, as well as the key components of the Sun Life Benchmark report.
Using benchmarking data- Case study
As an extension to traditional funding arrangements, learn more about why employers may want to consider level funding and reference-based pricing.
Other funding arrangements- Level funding and Reference-based pricing
Gain insights on top claim conditions, million-dollar claims, injectable drugs, and trends we are seeing since the COVID-19 pandemic.
High-cost claims and injectable drug trends
External Presentation
Learn more about Sun Life's Clinical 360 and Health Navigator offerings, including case studies and success stories!
Strategies for improving care and cost outcomes
Learn about the role that cost-containment and care optimization play in saving self-funded employers time and reducing costs.
The importance of cost-containment and care optimization
Make informed stop-loss decisions about coverage and potential claim implications using Sun Life's high-cost claims and injectable drug trends report and benchmarking data in an interactive experience.
Using data to create a successful Stop-Loss plan – Interactive Experience
Sun Life Broker Education Library
Important role that stop-loss plays in self-funding
Employer decision points around stop-loss
Employer decision points - other funding arrangements
Understanding stop-loss product offerings
Using benchmark data to make stop-loss decisions (Case study)
Securing a stop-loss quote
Strategies for improving care and cost outcomes
Medical and RX claims trends (Research Report)
Using data to create a successful stop-loss plan (interactive experience)
Self-funding overview
Interactive experience that combines Sun Life's High-cost claims and injectable drug trends report and benchmarking data together
Sun Life stop-loss leadership and strength:
• Sun Life stop-loss snapshot
• Premium history
Insights and tools:
• Insights and education
o High cost claim trends
o Benchmarking
o Self-funding guidance
• Product snapshot
Using data to create a successful stop-loss plan – interactive experience
• Link to tool that can be clicked into/customized for client/broker needs
o Prevalence of a high-cost claim
o Understanding coverage types
o Selecting deductible levels
o High-cost claims based on deductible levels
o Stop-loss product features
Exploring two approaches to respond to risk and the key benefits of self-funding
What is self-funding?
• How to businesses respond to risk?
o Fully insured
o Self-funded
Key benefits to self-funding
• More flexibility and financial control
• Increased claims data
• Conversion options (captives & level funding overview)
Market insights
• Brokers share clients perspective (top 5 reasons/concerns around self-funding)
• How often are covered workers enrolled in a self-funded plan?
Broker best practices
• Identify the right candidates & start the discussion
• Use financial modeling
• Select the right plans and features
What is stop-loss, what factors impact stop-loss rates, and how you can buy stoploss, including both specific and aggregate options to consider
What is stop-loss insurance?
• Key terms
o Stop Loss insurance, deductible, claim, reimbursement
• How do businesses respond to risk?
o Fully insured; Self-funded with stop loss; Self-funded without stop loss
How does it work?
• Stop loss caps the risk
• Specific stop-loss coverage
o How often do employers buy specific stop-loss coverage?
o How common is a stop loss claim & stop loss deductibles by case size
• Aggregate protection
o How often do employers select aggregate coverage?
o What is an aggregate corridor
o How does aggregate stop loss work?
• How the specific and aggregate deductibles work together
• Specific and aggregate integration example
What funding arrangements exist, who administers claims, options between bundled and unbundled stop-loss solutions
Funding arrangement
• Two approaches to consider: fully insured & self-funded health plan costs
Claims administrators
• Who administers claims? Administrative services only (ASO) vs. third party administrator (TPA)
• Unbundling
• What does the marketplace do?
Key considerations in your stop-loss coverage
• Pharmacy benefits
• Plan language
• Employer factors
• How stop-loss caps the risk
• What to look for in a carrier
Other methods of self-funding
• Captives, level-funding, reference based pricing
*learn more in the next deck!*
Learn more about level funding, captives as a method of switching to self-funding, and what reference-based pricing is and can mean for clients
Level funding
• What is it and how does it work
• To level fund, why or why not & who is a good fit
Captive arrangements
• What is a captive & captive program structure
• Why employers choose captives & who is a good fit
• Questions to ask a potential captive partner
An introduction to reference based pricing (RBP)
• What is reference based pricing & how is a claim repriced
• What is Sun Life seeing & questions to ask
• Who is a good fit for RBP
Provider choices
• Covered workers in a self-funded plan by firm size
• Where can you buy stop-loss?
• Unbundling can be a seamless experience
Comparing stop-loss contracts and features, such as features for cash flow protection, key product features, and other considerations
Contract Types
• Common stop-loss contract types
• Run-in coverage
• Claims timeline for a “rolling” 12/15 contract
• Gapless renewal provision
Stop Loss Features
• Cash flow protection
o ASO reimbursement, Advance funding, Monthly aggregate accommodation
• Product features
o No new laser at renewal, Mirroring, Aggregating specific,
Experience rating refund, Terminal liability (TLO)
• Other considerations
o Disclosure, FIRM, Rate locks, Run-in limits, Rx carve-out, Clinical
360
Follow a case study that demonstrates the importance and value
of benchmarking and the key components of the Sun Life Benchmark Report
Sun Life stop-loss benchmark background
• Sun Life Stop-loss snapshot
• Stop-loss benchmark background & why is benchmarking important
• What do employers want to know? Broker & Employer Voices survey
Benchmarking case study
• Employer profile & potential topics of discussion
• Checklist
• Funding arrangement
• Claims administrator
• Key demographics
• Risk profile
• Specific and aggregate coverage
• Projected number of stop-loss claims
• Likely stop-loss claim conditions
• Stop-loss carrier
How to submit a stop-loss quote, including the analysis and understanding of market factors and case factors that you should be aware of
Two approaches to consider
• Funding arrangement comparison
• Components of a self-funded plan
• Employer factors that affect stop-loss rates
Requesting a stop-loss quote
• Submit request for a quote & supporting data
• Risk assessment process
Case-level factors that affect stop-loss rates
• Demographic impact; Contract type; Network impact; Contract features; Disclosure; What does firm mean?
Market factors that affect stop-loss rates
• Lasers; Members with claims over $1M; Likelihood of stop loss claims; Managing leveraged trend
Timelines
• Key points for New Business quoting
• Life cycle of a Renewal
This course gives an overview of cost containment and explores our Clinical 360 and Health Navigator offerings including case studies and success stories
Overview of cost containment
• Behind every claim is a person facing a health challenge
• Common concerns
Clinical 360
• Our Clinical team
• Clinical 360 overview
• The Clinical 360 process
• Clinical 360 Success Stories
Sun Life Health Navigator, powered by PinnacleCare
• Supporting members in the moments that matter
• Sun Life Health Navigator & what is covered
• Why is this even more important right now?
• Our process
• Member experience timeline
• Health Navigator success stories
• Measures of success
Trends in high-cost claim conditions, million-dollar claims, and injectable drugs and why stop-loss is important
Top 10 high cost claim conditions
• Top Diagnoses; Expected cost range; Ten years of high-cost claims; High- cost conditions by deductible; Stop-loss deductible by case size; Cancer: why it’s the top claim even during a pandemic; Covid-19 claims; Trends in the ‘new normal’; Mental health
Million dollar claim trends & injectable drugs
• Top 20 high cost injectable drugs
• Rise of million dollar+ claims & $3M+ claim analysis
• Legislative update
Importance of Stop-Loss Coverage
• Importance of stop-loss coverage
• Claim costs reimbursed by stop-loss coverage
Recommendations
• Environment, medical & RX, and stop-loss recommendations
FOR PRODUCER USE ONLY.
Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except
New York, under Policy Form Series 07-SL REV 7-12. In New York, group stop-loss insurance policies are underwritten by Sun Life and
Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12. Product offerings may not be available in all
states and may vary depending on state laws and regulations.
© 2022 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life and the globe symbol are
trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us. GSLCR-10896 SLPC 31406 02/22 (exp. 02/24)
Using data to create a successful stop-loss plan
(interactive experience)
Medical and RX claims trends (Research Report)
Strategies for improving care and cost outcomes
Securing a stop-loss quote:
How stop-loss carriers underwrite risk & set rates
Using benchmark data to make stop-loss decisions
(Case study)
Understanding stop-loss product offerings
Employer decision points:
other funding arrangements
Employer decision points
around stop-loss
Important role that stop-loss
plays in self-funding
Self-funding overview
Self-funding overview
Important role stop-loss plays in self-funding
Other funding arrangments: Captives
Using benchmark data: Case study
Employer decision points around stop-loss
Stop-loss product features
Contract types and cash flow options
Other funding arrangements: Level funding and Reference-based pricing
Rate setting and new business underwriting
Renewal underwriting and setting rates
Using data to create a successful stop-loss plan
High-cost claims and injectable drug trends External Presentation
The importance of cost containment and care optimization
Strategies for improving care and cost outcomes
The importance of care navigation and self-advocacy
Additional resources:
Broker Education
Resources
Benchmarking
overview
2022 high-cost claims report
Clinical 360 information
DESCRIPTION HERE
Interested in learning more about our Broker Education series? Click into a topic below to see a description of what is in each presentation. Reach out to your stop-loss representative to schedule a meeting today!