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Provider Stop Loss Insurance

Under the terms of new managed care contracts, physician groups and hospitals will share risk and accept reimbursement on a "global payment" basis. While advances in treatment and technology benefit patients, the cost of a single claim can quickly escalate beyond budgets.

To address this financial risk, Provider Stop Loss Insurance is designed to limit healthcare providers' financial responsibility to specific limits per patient annually. This coverage is designed to allow the medical group to participate fully in the shared savings potential, while reducing the risk of the accompanying shared financial risk if individual patient health care costs were to exceed pre-agreed limits.

Specific Stop Loss Coverage Solutions

  • limits financial responsibility to a specific dollar amount, for the services to a patient, during a 12-month policy period
  • managed care contracts vary and the Stop Loss policy can be tailored depending on a group's risk tolerance
  • a variety of deductible and coinsurance options are available

Purchasing Stop Loss Coverage

Medical groups may purchase provider stop loss policies to insure all of the members covered by the managed care contract for a 12-month contract period. The payment method is a fixed dollar fee, paid on a per-member per-month basis. A medical group may purchase one stop loss policy to cover all of their managed care contracts including Commercial, Medicare and Medicaid populations. The deductible and the coinsurance may be tailored for each population.

For more information, please call Chip Moynihan at 781-434-7398.

Contact PIAM

  • Telephone Numbers
781-434-7525 Insurance All Departments
781-434-7398 Medigap, MMS Member Benefits, Health, Financial Services, and Long-Term Care
  • Fax Number
  • 781-434-6929