OUR PROCESS: The 40 Point Inspection

Meticulous analysis and expert RFP management that gives you confidence in every presentation

Stop-loss placements fail when critical details get overlooked. A missing contract provision. An incorrectly structured deductible. An SPD that doesn't mirror the policy. These aren't small issues—they're the difference between a solution that works and one that creates problems down the road.

Our 40-point inspection ensures nothing gets missed. From stop-loss contract analysis to pharmacy benefits evaluation to financial reserve planning, we can examine every element that impacts your client's success. The result? Clean RFPs, competitive quotes, and presentations you can deliver with complete confidence.

What We Examine

Stop Loss Contract Analysis

We analyze every aspect of your client's stop-loss coverage to identify opportunities and risks:

Coverages - Comprehensive review of what's included and excluded
Specific Deductible Analysis - Optimal deductible selection for client's risk profile
Aggregating Specific Analysis - Evaluation of aggregating specific structures
Specific Advance Analysis - Review of advance funding provisions
Ratings and Financials - Carrier financial strength and stability assessment
Lasering at Renewal - Strategic approach to individual high-cost claimants
Second Year Rate Cap - Protection against excessive renewal increases
Minimum Attachment - Aggregate attachment point analysis
Plan Mirroring - Ensuring policy matches plan design exactly
IRO Provision - Independent Review Organization language review
Never Events - Coverage for preventable medical errors
Run-in Limitations - Pre-effective date claim liability review

Plan Document Review

Your client's plan documents must be accurate, compliant, and properly executed:

SPD: Eligibility Review - Comparison against personnel policies for consistency
SPD: Signed and Approved - Proper execution and approval documentation
Amendments: Signed and Approved - Proper amendment documentation and execution
Extraneous Personnel Policies/Procedures - Comparison with SPD for alignment
SPD/Policy: Exclusions - Alignment between SPD and policy exclusions
SPD/Policy: Usual and Customary Language - Clarity on reimbursement methodology
SPD/Policy: Clinical Trials/E&I Language - Experimental and investigational coverage terms

Network & Cost Containment

We evaluate the full ecosystem of vendors supporting your client's plan:

PPO Evaluation - Network adequacy and discount performance
In-Network Utilization - Analysis of network steerage effectiveness
Out-of-Network Pricing - Review of OON reimbursement methodology and costs
Bill Audit/Review - Claims audit process and recovery potential
Utilization Review - Pre-certification and medical necessity review effectiveness
Disease Management - Chronic condition management program evaluation
Dialysis Cost Containment Language - Specialty cost management provisions
Transplant Carve-Out Evaluation - High-cost procedure management strategy
Telemedicine Analysis - Virtual care utilization

Pharmacy Benefit Analysis

Pharmacy costs require specialized attention:

PBM Contract Analysis - Transparency, rebates, and pricing structure review
Generic Drug Utilization - Generic substitution rates and opportunities
Specialty Drug Utilization - High-cost specialty medication management and alternatives

Financial Planning & Reserves

Sound financial planning prevents cash flow problems:

Illustrative Fully Insured Equivalent Rates - Cost comparison to fully-insured alternatives
Illustrative Continuation Coverage Rates - Accurate continuation coverage premium calculations
Plan Funding Methodology - Optimal funding approach for client's cash flow
IBNR Reserves - Incurred But Not Reported liability estimation
Stabilization Reserves - Reserve requirements for claim volatility
Fee Based Versus Commission Analysis - Evaluation of fee-based and commission structures
Contribution Strategy - Employer/employee cost-sharing optimization
Tax Savings Estimates - State premium tax savings quantification

What Brokers Can Expect

Week 1: Data Collection & Initial Analysis

We gather all necessary information—claims data, plan documents, census, and current contracts. Our team conducts the initial 40-point inspection to identify issues requiring immediate attention.

Week 2: RFP Development & Carrier Selection

We develop comprehensive RFPs and select the optimal carrier mix based on your client's needs, risk profile, and market conditions. Our carrier relationships ensure your case gets proper attention.

Throughout the Process:

  • Regular updates on quote status and timeline
  • Clear communication about any issues or opportunities discovered
  • Proactive problem-solving when challenges arise
  • Clean, organized presentation materials ready for your client meeting

Result:

  • RFPs that carriers love to quote
  • Presentations you can deliver with confidence
  • Solutions that actually work

"I love your RFPs. The material you send over is so nice… they are like perfect little packages!"

Account Manager

Stop-Loss Carrier

Experience the difference meticulous preparation makes.

Let's Discuss Your Next Case