Standard Stop Loss Employer Disclosure Form Endorsed
The Self-Insurance Institute of America ( www.SIIA.org ) and the Society of Professional Benefit Administrators (www.SPBATPA.org) have endorsed a standardized stop-loss disclosure form, which also includes ICD-9 codes. The documents are intended to help facilitate the sharing of health data information between self-insured entities/TPAs and stop-loss insurers/MGUs for the purpose of medical stop-loss underwriting. ]
The Employer Disclosure, required by most stop loss carriers and MGUs, has grown in sophistication and use. Today, most stop loss sources require an employer disclosure before a new or renewal quote is offered. Ideally, the Employer Disclosure lists all known high cost claims, claims that have exceed a given dollar threshold, or patient/employees with certain diagnoses. Failure to disclose these individuals can later lead to claim denials.
For the past several years, an industry study group has worked on "standardizing" the reporting process with the objective that all insurers would come to accept the reporting system/form as an industry standard. Latest Survey Results Recommending Adoption Respondents from the self-funded community have voted 86% in favor of adoption of the standard form for stop loss disclosure.
For all survey results, see www.MyHealthGuide.com/disclosures.htm. Disclosure Form, Codes, White Paper, Available The following draft documents may be downloaded and viewed at www.myhealthguide.com/disclosures.htm Standard Disclosure Form and Codes (with instructions) Word Format Standard Disclosure Form and Codes (with instructions) Acrobat PDF Format Stop-Loss/Reinsurance Disclosure & Reporting "White Paper"
The Employer Disclosure, required by most stop loss carriers and MGUs, has grown in sophistication and use. Today, most stop loss sources require an employer disclosure before a new or renewal quote is offered. Ideally, the Employer Disclosure lists all known high cost claims, claims that have exceed a given dollar threshold, or patient/employees with certain diagnoses. Failure to disclose these individuals can later lead to claim denials.
For the past several years, an industry study group has worked on "standardizing" the reporting process with the objective that all insurers would come to accept the reporting system/form as an industry standard. Latest Survey Results Recommending Adoption Respondents from the self-funded community have voted 86% in favor of adoption of the standard form for stop loss disclosure.
For all survey results, see www.MyHealthGuide.com/disclosures.htm. Disclosure Form, Codes, White Paper, Available The following draft documents may be downloaded and viewed at www.myhealthguide.com/disclosures.htm Standard Disclosure Form and Codes (with instructions) Word Format Standard Disclosure Form and Codes (with instructions) Acrobat PDF Format Stop-Loss/Reinsurance Disclosure & Reporting "White Paper"
