Typical Situation
When an advisor or TPA is trying to win a new case, the typical process to obtain a stop-loss quote usually encompasses creating a package of information for the underwriter to review. The package usually includes a census, current plan design, monthly claims data if available or premium history and sometimes large claimant information. If an underwriter sees excessive high cost claimants or claims data that is higher than expected, they usually don’t spend a lot of time on the case and often times decline to quote. If they do provide a quote, it’s usually based on the current information without regard to any potential cost savings opportunities that could be applied going forward. This situation usually makes the quote uncompetitive and the advisor/TPA is unlikely to win the case
Our goal is to provide the underwriter with compelling information about the case, as much details on the high cost claimants and potential cost savings initiatives that will be applied if the case is won. If the underwriter understands the employer’s motives, how serious they are to make a change, any point solutions that may reduce high cost claimant costs, etc., the underwriter will be more willing to spend time on the case attempting to produce a competitive quote. We do not believe stop-loss should be the ‘value proposition’ utilized to close cases however we understand it must be competitive and believe our process provides more competitive quotes.
Value Proposition
RFP Preparation & Case Diagnosis:
• Organize RFP files to accommodate the stop-loss underwriter.
• Determine proposed PPO/RBP vendors. PPO/RBP strength will be identified by zip codes and claims data (if available).
• Review and ensure appropriate specific deductibles and aggregating specs are set as well as contract terms (12/12, 12/15, etc.).
• Review any available large claims reports / individual medical questionnaires (IMQs) to determine potential lower cost solutions. Communicate potential solutions to stop-loss partners.
o Bid potential large claims out to vendors during pre-underwriting.
• RFP will be submitted to a preferred panel of stop-loss partners (your preferred partner can be included) based on group size, stop-loss partner niche and product needs.
o An overview of the case will be provided including all background information on large claims, how the case is currently running, etc. This will prevent the ‘auto’ declines from underwriters.
• Create summary page on prospect including but not limited to: average age, claim cost / employee, pharmacy spend compared to total spend, large claim concerns, potential solutions / alternatives.
Negotiation
If there are lasers, offer alternative options to help reduce liability by proposing cost effective strategies to help lower a laser’s liability.
Ensure proper premium credits are realized for proven cost containment/trend management solutions.
Ensure quotes are competitive and justified based on the information provided and the cost management programs that are proposed.
Proposal/Solution Preparation
Summarize and compare solution/quotes to the current/renewal rates
o Highlight key differences between incumbent and proposed offer
Example - fee for service vs DCP
Outline best case, expected and max cost
• Carrier/MGU will know quotes coming from this service are well vetted and trust worthy, thereby reducing denials and producing better rates. Full discloser to reduce risk to everyone involved (carrier, TPA, broker/advisor, employer).
• Ability to close more cases, increasing your close ratio.
• Reduced labor costs to you by removing the burden from your staff. Allowing additional time for them to focus on your customers or new prospects.