Stop Loss

Stop Loss Prescription

Reset Healthcare has identified the most efficient means to drive consumer engagement through technology, advocacy, and vendor resources. By embedding risk management into the stop loss, we empower members to become true consumers of healthcare.

  • Our Medical Stop Loss products are provided through our relationships with A+ rated (AM Best) Reinsurance Carriers.

  • Coverage is available based on a minimum group size of 50 enrolled employees and a minimum specific deductible of $25,000.

  • Coverage available for both specific and aggregate contracts is consistent with industry standards, multiple contract options available, 125% corridor is standard but flexible corridors may be available.

  • Aggregating Specific option is available.

  • Rate guarantees and 90-day locks on pricing available (subject to final disclosure) may be available for certain groups.

  • We are proud of our 94% retention rate.

  • Pricing is based on “underwriting bias”, not “experience rating”.

  • Referenced based pricing is available.

Embedded Risk Management Tools

Risk Management

Keys to Controlling Costs & Success: All Tools and Services are accessed through a personalized APP, phone, text, email or tablet. Available in iOS or Android.

  • Increase employee engagement through health advocates serving each employee and dependents 24/7;

  • Access to a national provider network that includes direct primary care and a broad range of specialists and inpatient and outpatient providers;

  • Personal health advocates assist employees/dependents select a primary care physician, schedule an annual wellness visit and address any chronic conditions they may have;

  • Unlimited telehealth for both medical and behavioral needs is included, both services provide convenient video visits or calls when primary care physicians or specialists are unavailable.

  • There are no limits to nurse case management to prevent and improve the chronic conditions of employees;

  • Members obtain pre-certification approval of inpatient and certain outpatient and diagnostic services as defined in health benefit plans;

  • During pre-certification, health advocates communicate with employees to assist with provider selection for quality and price transparency options and to coach employees to choose high value, lower cost in-network providers.

  • A transparent pharmacy benefits manager (“PBM”) and specialty drug cost reduction program will lower drug expenses;

  • Cost effective vision benefits are included with optional onsite employee screening programs.

Ready to talk?

We love our customers, so feel free to contact us for a no contact visit via webinar or Zoom meeting.

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