Skip to main content

Questionnaire: Stop Loss Carrier Approval Info Checklist

Carrier Data

1. Please submit a copy of the most recent year's annual financial statement for the carrier

2. Please provide the following ratings for the carrier over the past 3 years. If there are any downward changes please explain:

A. Best

B. Standards and Poor

C. Moodys

D. other

3. Describe the carriers involvement in the stop-loss business from the time they first began

Writing stop-loss. Please explain any years in which they ceased writing or renewing the business.

4. Describe how your stop-loss business is sold and administered. (Direct, broker, Third Party Administrators.)

5. What was the carriers premium volume from medical stop-loss business for each of the last three years?

6. Describe your reinsurance arrangements including the names of those reinsurers and note those who assume the largest share of the risk. What percentage of the risk do you maintain?

7. Please list any states in which the carrier and it's sister companies are not writing stop-loss?

8. Does the carrier own any interest directly or indirectly in a Third Party Administrator?

9. How much ASO and minimum premium business does the carrier write?

10. If the services of one or more MGUs are used, please list the name and addresses of those MGUs

11. Please provide the name and address of those underwriting firms.

Disclaimer: This Questionnaire Is Not A Legally Binding Document

Managing Underwriter

1. Name, address and phone. (Include branch locations)

2. Please submit a copy of your most recent year's annual financial statement.

3. Please provide the names of the principals and key personnel. (Attach resumes)

4. Describe any ownership interest between the MGU, its officers, directors, or owners, and the carrier or reinsurers which assume the business underwritten by the MGU.

5. Describe any ownership interest between the MGU, its officers, directors, or owners, and any Third Party Administrators which administer the business underwritten by the MGU.

6. What duties does the MGU perform on behalf of the carrier (e.g., claims payment, premium collection, underwriting, etc)? What duties does the carrier reserve for itself?

7. MGUs stop-loss history
a. When did you first begin business?
b. List all stop-loss carriers you have used during the last 5 years.
c. List the annual medical stop-loss premium for the above carriers for each of the last 3 years.

8. Which carriers does the MGU represent for stop-loss coverage?
MGUs to complete carrier data page for each carrier.

9. Do any of those carriers write stop-loss coverage directly or through other underwriting managers?

10. Does the MGU carry a fidelity bond? E & O coverage? Crime coverage? If yes, please attach copies of the declaration page.

Disclaimer: This Questionnaire Is Not A Legally Binding Ddocument

Underwriting Data

1. Please provide a checklist or data form showing the basic information you will expect to receive to be able to to provide a proposal.

2. If the information needed to renew a case differs, please note that information is need at renewal.

3. How long does it take for you to issue a proposal once you have all the necessary data?

4. Please provide an expected time line for renewal rating (i.e., when do you require renewal data, how much prior to the anniversary will rate be given, etc.).

5. For new cases, describe how known ongoing large claims are handled (i.e., actively at work, higher deductibles, lazering out, rating up, etc.). Be specific.

6. Discuss your renewal philosophy. Be specific as it relates to known ongoing large claims, lazering out, and rating up.

7. Has a renewal ever been denied solely due to experience.

8. Are Taft-Hartley, MEWA, Association, or other non-single employer groups eligible?

9. Do you require life insurance coverages? If yes, what coverages?

10. Do you underwrite coverages other than stop-loss? If yes, what coverages?

11. Do you give rate credit for managed care programs such as PPOs and UR? If yes, what data do you need to determine a credit?

12. Do you or can you change rates or factors during a contract year? If yes, please explain.

13. To what extent will you perform late entrant underwriting on behalf of the employer?

14. What is your minimum number of lives, minimum attachment point and specific deductible?

15. Describe your binding authority and at what point is coverage bound?

16. Has a renewal ever been declined due solely to poor experience?

Disclaimer: This Questionnaire Is Not A Legally Binding Document


1. What information do you require to process a specific stop-loss claim?
An aggregate stop-loss claim?

2. How long does it typically take for you to pay both specific and aggregate claims?

3. Describe you claim auditing procedures

4. Do you require an audit of large hospital bills? If yes, at what level?

5. If hospital audits are performed, do you pay for them? Under what circumstances do you pay the cost?

6. What proof of payment is required for specific and aggregate claims?

7. What is your definition of a paid claim?

8. To what extent will you honor non-contractual claims?

9. How do you handle very large claims where the group cannot fund the entire amount? (i.e, will you release your payments before the plan pays, concurrently, other?)

10. Do you participate in special claim Administration costs such as subrogation expenses? Defense of lawsuits? Other? If so, under what circumstances? 11. If you purchase reinsurance protection, does the reinsurer need to review all claims before they are paid, or are your decisions binding on the reinsurance?

12. If a claim is delayed (i.e., for subrogation) beyond the end of the contract period, do you grant a waiver of the time limits for payments if the circumstances are reported to you prior to the end of the period? If no, how are such claims handled?

13. Do you require that large claim management services be used? Under what circumstances? Do you pay for such service?

14. Do you accept the Plan's reasonable and customary determinations? If no, what measure do you use?

Disclaimer: This questionnaire Is Not A Legally Binding Document


1. Please provide a sample contract for our review. Is your contract a reimbursement only contract?

2. Will all contracts be issued in this format? If no, please explain.

3. Do you issue the contract to the plan? The plan sponsor? Other?

4. What data do you require to issue the contract?

5. Once you have all required information, how long does it typically take to issue a contract, both life and stop-loss?

6. Are there any exclusions in your excess risk contract?

7. What runout provisions are allowed on your specific contract?

8. Describe any situations in which a service rendered within a policy year might not be covered because of contractual provisions (i.e., a claim paid in the 16th month under a 12/15 contract, claims where notice is not provided within x days, etc.).

9. To what extent do you require a specific Plan Document provisions? Do you provide prototype Plan Documents?

10 Do you have an "actively at work" provision? What are the procedures for waiving it?

11. Describe how you cover or assume liability on participants who incur claims after the date of sale and before the effective date.

Disclaimer: This Questionnaire Is Not A Legally Binding Document


1. Please provide a list of names, title and phone numbers for key contact persons for claims, underwriting, sales, etc.

2. Do you provide sales bonuses, profit bonuses or other items or services of value to your producers? If yes, please explain.

3. Please provide a copy of your commission schedule.

4. Will you write coverage with no commission? Is there a price differential? If yes, how much?

5. Do you send form 5500 Schedule A for stop-loss contracts you issue?

6. Under what circumstances do you correspond directly with the policyholder?

7. Do you provide quotes through more than one source of business, or is it FIFO? Explain.

8. Will you allow a case to transfer from one Third Party Administrator to another? Explain.

9. Do you give exclusive area contracts or limit the number of TPAs in a given area?

10. Please provide the names, addresses, and phone number of five Third Party Administrator references.

Disclaimer: This Questionnaire Is Not A Legally Binding Document