Stop-Loss Marketing Best Practices: A Broker's Checklist for Better Quotes

# Stop-Loss Marketing Best Practices: A Broker's Checklist for Better Quotes

Successful stop-loss marketing begins with preparation. Brokers who anticipate underwriting needs and present a complete, strategic picture can dramatically improve quote competitiveness and renewal stability.

## 1. Start with Data Readiness

Underwriters price risk based on credibility, and credibility depends on data quality.

### What to Provide
- **3-4 years of monthly paid claims** (not just 12-24 months)
- Large claimant details with diagnosis codes
- Monthly claims with enrollment counts
- Plan designs and benefit summaries
- Pharmacy claims separated from medical

### Why It Matters
Complete, clean data allows carriers to apply more weight to experience-based pricing, reducing reliance on conservative manual rates. The difference between 2 years and 4 years of data can significantly impact credibility weighting.

## 2. Disclose Specialty Drug Utilization

Specialty pharmacy is a persistent headwind in underwriting. Proactively disclose:

- Current specialty drug utilizers
- High-cost medication list
- Site-of-care strategies in place
- Prior authorization programs
- Biosimilar substitution policies

Carriers appreciate transparency and may view managed programs favorably.

## 3. Plan Ahead for Leveraged Trend

Stop-loss liabilities rise faster than medical inflation. Advise employers to consider:

- **Annual ISL deductible increases** to offset trend
- **Aggregating specific deductibles (ASDs)** for premium relief
- **Multi-year rate cap negotiations** for stability
- **Budget reserves** for trend-driven increases

These strategies help mitigate leveraged trend and stabilize renewals.

## 4. Address Gene Therapy Exposure Early

Multi-million-dollar therapies are here. Before marketing:

- Evaluate carrier gene therapy programs (embedded vs. standalone)
- Understand coverage limits and exclusions
- Consider non-drug costs like inpatient care
- Identify known gene therapy candidates in the population

Proactive planning avoids surprises and positions the group for sustainable pricing.

## 5. Highlight Cost-Containment Programs

Underwriters increasingly look for programs that manage high-cost conditions:

| Program Type | Examples |
|--------------|----------|
| Cancer Care | Centers of excellence, case management |
| Infusion Therapy | Site-of-care optimization |
| Dialysis | Specialty vendor partnerships |
| Transplant | Network steering, bundled pricing |
| Specialty Pharmacy | Prior auth, step therapy, biosimilars |

These solutions demonstrate risk mitigation and can influence underwriting favorably.

## 6. Match Carrier Philosophy to Group Profile

Not all carriers view groups the same way:

| Group Profile | Best Carrier Type |
|---------------|-------------------|
| Adverse/volatile experience | Manual-heavy carriers |
| Strong historical performance | Experience-heavy carriers |
| At pricing floor | Carriers with lower floors |
| No claims history | AI-enabled underwriters |

Understanding philosophies—and aligning them with the group's risk story—is critical for maximizing competitiveness.

## 7. Navigate Regulatory Requirements

State-specific rules can limit carrier flexibility:

- Confirm minimum attachment point requirements
- Verify filing requirements in the state
- Check for state-specific mandates affecting stop-loss
- Reference the [NAIC Stop-Loss Insurance Model Act (#92)](https://content.naic.org/sites/default/files/inline-files/SLI_SF.pdf)

Address these early, especially for small and mid-sized groups.

## The Broker Checklist

Before submitting an RFP:

- [ ] 3-4 years of monthly paid claims
- [ ] Large claimant detail with diagnoses
- [ ] Current enrollment and plan designs
- [ ] Specialty drug utilization summary
- [ ] Cost-containment program descriptions
- [ ] Gene therapy program evaluation
- [ ] Carrier philosophy alignment analysis
- [ ] State regulatory requirements confirmed

## Key Takeaways

- Data quality directly impacts quote competitiveness
- Proactive disclosure builds carrier confidence
- Cost-containment programs influence underwriting
- Carrier selection should align with group profile
- Preparation prevents renewal surprises

*This article is part of our series on stop-loss underwriting. For a comprehensive overview, see our whitepaper: [Stop Loss Underwriting: A Deep Dive](/resources/whitepapers/stop-loss-underwriting-deep-dive).*