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Choose one of three ways to get a competitive
quote for your medical stop loss insurance:
1. Submit the information listed
below.
2. Click
here to complete an online Quote Request Form.
3. Give us your medical stop loss
insurance agent's name and we'll work through him or her.
| Option 1: Submit the following
information. |
Provide the information listed below by fax, postal
delivery or e-mail.
• Fax to 508-799-0161.
• Mail or overnight to:
___American Stop Loss
___250 Commercial Street
___Suite 200
___Worcester, Massachusetts 01608
Send spreadsheet files on diskette in Excel or Lotus. Send word
processing documents- requests for proposals, for example- in Microsoft
Word or WordPerfect.
• E-mail to csmith@americanstoploss.com.
If you have questions or require priority 24-hour
turnaround, please call Cristine Smith at 800-944-7659, extension
3003.
If you're applying
for your quote directly
If you're responsible for the health plan benefits where you work,
please include your broker's name, address and phone. We will work
directly with him or her to support your needs.
If you're a broker
or consultant
Specify the organization to which the quote applies and the location
of the account. Give both the account home office and the location(s)
for which the quote applies.
For specific excess,
we will need the following:
1. Age/sex band report which shows
type of coverage (individual/family). If a band report is not available,
please send complete census.
2. Include a ZIP code breakdown
if the organization has multiple locations.
3. Description of the nature of
the business and its Standard Industrial Classification (SIC) code.
4. Large loss reports which show
current and previous 12 months' claims in excess of 50% of your
deductible. Include diagnosis and prognosis for these people if
available.
5. A copy of the self-funded plan
document(s) or plan summary(ies).
6. Current stop loss rates, deductible
level, contract type (i.e., 12/12, 12/15, 15/12, etc.), current
carrier and any contract limitations or exclusions.
7. If specific coverage is to
include other products (dental, vision, prescription drugs), please
include plan documents and historical claims data.
8. State quote requirements, effective
date, deductibles, contract types, maximum liability and quote deadline.
For aggregate excess,
we will need:
1. Monthly claims and enrollment
for the most recent 24 months available.
2. Current medical attachment
factors, contract type (i.e., 12/12, 12/15, 15/12, etc.) and premium
amount.
3. If coverage is for additional
products (dental, vision, prescription drugs), please include historical
claims data as well.
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