Stop Loss Insurance

Mitigate risk and minimize your loss

Manage the financial risk of your group medical plan and control your medical costs with Stop Loss coverage. Stop loss is designed to protect employers with self-funded health plans when their group medical costs are higher than anticipated, or when employees or their dependents experience catastrophic illness or accident.

Why choose Stop Loss Insurance? Optum™ has earned its reputation for reliable service by offering:

  • Experience. We have more than 25 years of experience with underwriting and claims management.
  • Flexibility. Employers with 50 or more employees choose from different policy options and a range of deductibles.
  • Refunds. Optum provides refunds for good claims experience through our Experience Rewards option.
  • Promptness. 90 percent of claims are paid within 10 days.

Features of Optum Stop Loss Insurance:

  • Specific and aggregate coverage. Specific coverage protects your organization against high individual claims when employees incur extensive health care costs, and aggregate coverage manages claims incurred by your entire group.
  • Flexible policy options. Whether you employ 50 employees or 10,000, you can determine the amount of coverage you need — and the amount of risk you’re willing to take — by choosing from different policy options and a wide range of deductibles.
  • Timely reimbursement. If you reach your stop loss deductible limit, your claim will be reviewed within 10 days of submitting your request.
  • A transition program. Available for companies with 50-200 employees, the Fully Insured Transition program helps you switch from a fully insured program to a self-funded program

Benefits of our Stop Loss Insurance:

  • Access to Optum Centers of Excellence Network. Our Stop Loss Program includes access to top, credentialed facilities for transplant, cancer and other catastrophic health conditions. Negotiated discounts with these facilities ensure lower costs for you, better care for your employees.
  • Reduced deductible. With our step-down deductible feature, your specific deductible is reduced by 15 percent when a covered participant receives care at a pre-approved Center of Excellence at the contracted rate
  • A medical management team. Our clinical experts consult with our underwriting and claims teams, as well as third-party administrators (TPAs) and case managers, to help manage your medical costs and improve patient outcomes
  • Reduced risk with the Managed Transplant Program. Add this fully insured carve-out option, which covers all transplant-related costs for a standard monthly premium

Add Optum Stop Loss Insurance to your self-funded plan.

To find a Stop Loss representative in your area click here: Stop Loss Insurance Quote

Stop Loss products are underwritten by Unimerica Insurance Company, UnitedHealthcare Insurance Company and Unimerica Life Insurance Company of New York, and in California, Unimerica Life Insurance Company.