What We Do

Stop Loss / Self Insured Coverage

Specific stop loss is available for 50 or more covered employees. It is offered as a stand-alone product, or in addition to our carriers’ aggregate stop loss coverage.

Features of Our Stop Loss Products

Specific and Aggregate coverage available for self-funded plans administered by TPAs and other Carriers
Full range of available contracts
Specific deductible levels – from $20,000 to $500,000
Specific Advance built into all quotes
Unlimited Lifetime Maximum per the new Health Care Reform Bill.
Options Include Aggregating Specific, Advanced Aggregate Funding, Terminal Liability
Optional Life and AD&D programs available

Simple Self Funding

Simple Self-Funding offers Employers that are currently Fully Insured to Self Fund their Health Benefits without high attachment point risk or renewal lasering concerns. This product offers commissions to the broker at 5% and are based off of the equivalent premium. Please review the product highlights below:

Overview of the Simple Self Funding™ Stop Loss Program

• Underwritten by Fairmont Specialty on behalf of United States Fire Insurance Company*
• No Lasering – First Year or Renewal
• Maximum monthly and annual cost for the Plan Sponsor
• No claims history required for underwriting currently fully insured groups
• ERISA program, no state mandates
• Group Self-Funded program
• Fully integrated cost containment
• Fully transparent rates, costs and expenses
• Competitive pricing
• HSA compatible plan options

Contract Considerations

• Specific and Aggregate Stop Loss Coverage
• 12/18 Contract (claims incurred in the 12 month contract year and paid in the contract year
or six months following)
• $25,000 Standard Specific Deductible
• Simultaneous Specific Reimbursement included on all accounts at no cost
• Advanced Monthly Accommodation included on all accounts at no cost

Minimum Group Requirements

• 15 Employees (maximum group size is 75 lives)
• 75% Participation of Eligible Employees
• 50% Employer Contribution towards Employee cost
• True Employer/Employee relationship

Life, ADD, STD and LTD

GROUP TERM LIFE / AD&D

• Available to groups of 15 or more employees.
• Flat benefits amounts or salary multiples.
• Dependent Group Life available.
• Non-contributory plans: Employer pays.
• Voluntary/Contributory plans: Optional or Supplemental plans; Employee pays.
• Include waiver of premium/conversion.

GROUP LONG TERM DISABILITY

• Available for groups of 25 or more employees.
• Benefit percentages: 50%, 60%, 67%.
• Benefit maximums: up to $25,000 per month.
• Elimination periods: 90, 180 or 360 days
• SS Integration: Primary, Full Family, 70% All Source, Backdoor.
• Own occupation definitions: 2 to 5 years, to age 65.
• Benefit durations: 2 to 5 years, to age 65.

GROUP SHORT TERM DISABILITY

• Available to groups of 25 or more employees.
• Benefit percentages: 50% to 70%.
• Benefit maximums: up to $1,500 per week.
• Elimination periods: 0, 7, 14 or 30 days.
• Benefit durations: 13, 26 or 52 weeks.

Fee Negotiation

Resolutia^®specializes in reviewing and negotiating medical claims, nationwide, for group health and workers’ compensation claims. With leadership of over 24 years in our field, Resolutia offers industry leading cost-containment services to payers across the healthcare and work comp spectrum. The highlights of our services are:

No appeals:

Resolutia always obtains a written sign-off from the provider—settlements are never contested—a hallmark feature of our services.

Exceptional turnaround time:

TAT is of utmost importance to payers and we take this fact seriously—turnaround on claims are managed by our claim reporting system and customer service focus.

Transparent in every way:

All terms of our agreements are fully disclosed to the provider and payer ensuring payment expectations and timeframes are always met.

Superior savings and success:

We’re only as good as our numbers and have areputation unmatched in the industry. Ask us about our no savings-no fee guarantee.

Ask us about our national PPO network partners that fill in the gaps in your primary PPO coverage.

Organ Transplant

Commercial Group Intermediaries offers a fully insured, first dollar organ and tissue transplant carve out for self funded groups. This remarkable benefit is encompassed in an admitted stand alone policy that can attach to any plan document, regardless of the stop loss carrier. The coverage begins at patient evaluation and extends 365 days post transplantoperation, and pays 100% of all covered transplant-related physician, hospital, and drug expenses when in network. A shorter benefit period is available.

Did you know?

As many as 40%-50% of all lasers imposed on self funded groups are due to transplant exposures.
The average waiting time for a solid organ is over a year. As a result, transplant patients usually jump over stop loss contract years, thus becoming magnets for imposed lasers or rate increases.
SMALL SELF-FUNDED GROUPS GENERALLY CANNOT INTERNALLY FUND A TRANSPLANT EXPOSURE AS ECONOMICALLY OR EFFICIENTLY AS THROUGH OUR CARVE OUT POLICY.

Coverage for the following Transplant Types is Offered:

Bone Marrow
Heart
Heart/Lung
Intestine
Kidney
Kidney/Pancreas
Liver
Lung
Pancreas
Stem Cell

Benefits to the Self-Funded Employer:

100% coverage on all major transplant types from first dollar to $1 million life maximum.
100% coverage for NCI Phase Trials III and IV for adults, Phases I through IV for pediatrics (this is a much more liberal coverage of experimental than most plan documents allow).
No deductibles for patients when in-network.
Liberal expense allocations for patients traveling to distant centers of excellence.
Benefit period covers from time of patient evaluation through 365 days post transplant, and includes hospital, physician and pharmaceutical expenses.
Direct payment by Medical Excess to providers, no cash flow issues for the employer.
Complete medical management and coordination of the patient with on-staff RNs.
Average cost of about $8.00 PEPM, a far less expense than the cost of a laser.
Contributes budget predictability and stability to Stop Loss rates.

Benefits to the Producer:

5% commission
Many stop loss carriers give a 2% to 10% credit on the specific stop loss for the transplant carve out, based on stop loss specific deductible.
TPA Partners are waived of group minimum size, thus becoming a competitive differential for groups looking for this coverage.
Extensive marketing assistance afforded to the producer from CGI to help sell the program.
A group can be eligible for this coverage regardless of their stop loss carrier, as long as they meet minimum enrollment requirements.
High renewal persistency among groups with transplant carve out.
Carrier management of transplant exposures allows administrator to redirect internal clinical resources to more chronic problems.

Which Groups Should Seriously Consider Adding This Coverage?

Unions and Associations often cap transplants at $250K and less, rendering it a less valuable benefit.
Large, completely self funded groups. Many don't want to sustain a single catastrophic hit such as Transplants and may have a high frequency issue.
Groups that have experienced a transplant exposure in the past or groups where a laser has played havoc with their stop loss insurance.
Groups that "have never had a transplant exposure". The best time to buy transplant insurance is when the group is completely clean of exposures.

Welcome to Medical Tourism.

For those of us who have not heard the term “Medical Tourism” it is very possible you will in the near future. Segments on 60 Minutes, Nightline, and articles in the Wall Street Journal have all indicated that Medical Tourism’s competitive pricing coupled with quality care will continue to push domestic medical needs to foreign markets. Medical Tourism is here to stay and is growing at an unpredicted rate. In 2008 projected medical travel was expected to reach 750,000 and in 2011 to exceed 9,000,000 which will revolutionize medical delivery in our country and the international sector. Hospitals in the international community and are JCI accredited and will compete with US Hospitals for patients on a global basis.

Why Medical Tourism?

In today’s self insured market Medical Tourism is an alternate choice and can be added to the Plan Document in a passive manner. How? By offering incentives to the employee in the form of waiving deductibles, coinsurance, and the out-of-pocket maximums and also offering spousal travel. The employer also benefits because his reimbursements for stop loss are less as illustrated below:

Procedure	U.S. Average	International Average
Heart Bypass	$145,000	$28,000
Heart Valve	$178,000	$22,500
Hip Replacement	$80,000	$14,000
Knee Replacement	$66,000	$12,000