Firms Offer Enhanced Stop-Loss Product for Employers That Self-Insure Health Benefits

In addition to seamless claims reimbursement, the new offering gives mutual clients convenient reporting, improved clinical and risk management, and the opportunity to share favorable results via a pooled experience.

Sun Life and Collective Health introduced an integrated stop-loss offering that gives self-funded employers financial protection from high-dollar health care claims, while helping identify better treatment scenarios to get their people the right care at the right time.

With their health plan and stop-loss coverage together on the Collective Health Workforce Health Management System, companies’ HR and finance executives now have more ability to predict, manage, and control costs around one of their largest, most important enterprise investments: health care.

The Employee Benefit Research Institute (EBRI) has seen a lot of interest in plan sponsors using self-insured health plans since the passage of the Affordable Care Act (ACA). In a survey published last year by Sun Life, nearly half of employers maintained that while cost savings is their biggest motivation to self-fund health benefits, overall financial risk is the biggest challenge they face. This combined stop-loss product helps control that risk.

In addition to seamless claims reimbursement—eligible claims will be automatically reimbursed by Sun Life weekly—the new offering gives mutual clients convenient reporting, improved clinical and risk management, and the opportunity to share favorable results via a pooled experience. Easy-to-understand reports within the Collective Health Platform’s Employer Suite provide a holistic view of claims data, enabling employers to make smart changes to health plan designs when it matters.

“For financial executives overseeing their companies’ self-funded health plans, high-cost claims can have a huge impact on their resources and bottom line. Now, companies can have better visibility into these claims, better controls to manage them, and can potentially be reimbursed before the claims hit their balance sheet, giving them more control of their health care expenses,” says Collective Health’s Chief Health Officer and Co-Founder Dr. Rajaie Batniji. “We’re excited to deliver this fundamental solution early in our strategic partnership with Sun Life, and look forward to a long line of offerings that will allow companies to harness the power of the employer-driven health care economy.”

The combination of Sun Life’s high-cost claims management expertise and Collective Health’s Workforce Health Management System will also help employers identify potential claims issues earlier in the process. Clients will have access to the Sun Life Clinical 360 program, in which nurse consultants analyze clinical and claim data, and work closely with Collective Health’s team to communicate with brokers and administrators on opportunities for savings, such as correcting billing errors or proposing treatment alternatives that reduce costs and provide patients with better care.

“We are very excited to be able to offer stop-loss to self-funded employers on Collective Health’s platform,” says Brad Nieland, vice president of Stop-Loss & Health at Sun Life. “The improved reporting, in conjunction with data and clinical expert-driven claims analysis, will offer employers the tools and knowledge they need to monitor and manage their self-funded plan while addressing healthcare costs and providing a great experience for plan members.”

The offering is available for quoting immediately, going live for joint clients on January 1, 2019. More information can be found here.