Stop Loss Group Underwriting

Underwriting medical stop loss is the core business function of Tokio Marine HCC - Stop Loss Group. In conjunction with superior underwriting services and products, we provide related value-added services such as catastrophic claim valuation through medical underwriting and actuarial review.

The products we offer are competitively rated, offering specific and/or aggregate stop loss insurance to employers with a minimum of 50 employees. Our goals are to offer tailor-made benefit packages, equitable rates and prompt and thorough service to both plan sponsors and third party administrators. We have both the experienced support staff and creative, knowledgeable underwriters to accomplish these goals.

Our Quote Submission Checklist indicates what is required for us to provide an accurate and competitive quote.

NetValue

We understand the dynamics within the changing managed care environment and is just one of the many value added services offered. Through NetValue, we continue to maintain its competitive edge in providing stop loss insurance for the self-funded marketplace.

How Is NetValue Used?

NetValue is a proprietary Tokio Marine HCC - Stop Loss Group program that evaluates the strength of health care provider networks. NetValue stands apart in the marketplace as a value-added support service for underwriting our medical stop loss business.

To get started, the provider network completes our Managed Care Network Questionnaire, maintaining a competitive edge.

We are always looking for superior network value in each of its markets. We are determined to participate with strong managed care organizations.

Network Marketing

Tokio Marine HCC - Stop Loss Group is nationally recognized as a leader in underwriting medical stop loss insurance. Evaluation and qualification of networks by Tokio Marine HCC - Stop Loss Group enhances a network’s marketability to brokers and third party administrators.

Through our Managed Care Network Questionnaire and CPT4 Codes List, our actuaries review each network for provider adequacy (type and count), access fees, hospital contracts, physician fee schedules, risk contracts and tertiary care arrangements. NetValue accesses credentialing procedures, medical management resources, practice patterns and outcomes. The data is matched against national benchmarks including Milliman USA’s Health Cost Guidelines, Medicare resource-based relative value scale and Solucient data.

Measuring Effectiveness

The results of NetValue’s analysis are continually reviewed against our paid claims database for accuracy. If warranted, modifications are made to pricing models. NetValue is an ongoing review program that rewards superior network value with the best discounts on stop loss premium.

Documents

Applications, forms & documents