Stop Loss Insurance Solutions
One catastrophic claim can significantly impact a self-funded plan’s budget for the year. Over the past decade, BCS has seen an 850% increase in claims exceeding $3 million. We offer specific, aggregate, reinsurance, risk share, and under-writing only stop loss solutions that help self-funded employers and health plans manage that risk.
What Is Stop Loss Insurance?
Stop loss insurance protects self-funded employers from the financial risk of unusually high medical claims. Because self-funded plans pay claims directly instead of a fixed premium to a carrier, one catastrophic claim — or a costly year across the group — can exceed what the plan budgeted. Specific stop loss caps exposure to any single high-cost claimant; aggregate stop loss caps the plan’s total claims cost across the group.
The need for this protection keeps growing. More than 60% of covered U.S. workers are now enrolled in self-funded health plans, and 87% of self-funded employers carry at least one stop loss policy today. Rising specialty drug and gene therapy costs are accelerating that need: BCS has seen an 850% increase in claims exceeding $3 million over the past decade.
Increase in claims exceeding $3M over the past decade
Of covered U.S. workers enrolled in self-funded plans
Of self-funded employers carry stop loss coverage
Can exceed a plan’s entire annual budget
Stop Loss Solutions from BCS
Five complementary ways to structure protection, for self-funded employers, health plans, and carriers of every size.
Specific Stop Loss
For self-funded employers. Coverage per individual participant that limits exposure to high-cost claimants. Available medical-only, or medical with Rx.
Aggregate Stop Loss
For self-funded employers. Coverage for entire group limits overall claims costs. Can include medical-only or a combination of medical with Rx, dental, and vision.
Reinsurance & Risk Share
For health plans and carriers. Multiple stop loss reinsurance and risk share arrangements, plus underwriting-only options, to help manage and mitigate risk.
Gene Therapy Stop Loss
For self-funded employers and health plans. Gene-therapy-only stop loss and reinsurance solutions (Stop Loss GT & GTS) that protect against $2M-$4M single-treatment claims.
Cost Containment Solutions
For plans and employers. Partnerships with specialty vendors and service providers supporting clinical intervention and cost-saving initiatives that manage exposure to high-cost claims.
Who We Serve
| Audience | Fit |
|---|---|
| Self-Funded Employers | Specific and aggregate stop loss coverage — combining medical, Rx, dental, and vision — to cap claim exposure and stabilize budgets. |
| Large / Jumbo Employers | Specific stop loss with flexible retention options, plus access to gene therapy and cost containment solutions for catastrophic claims. |
| Health Plans & Carriers | Reinsurance, risk share, and underwriting-only stop loss arrangements to manage aggregate risk across a book of business. |
| Brokers & Consultants | Quoting support and flexible plan design to structure the right stop loss program for each client. Rates available for upcoming plan. |
How It Works
1. Assess your exposure
Tell us about your population, current claims experience, and risk tolerance.
2. Get a tailored quote
Choose specific, aggregate, or a combined program, with reinsurance and risk share options available.
3. Protect your plan
Cap high-cost claim exposure so your plan’s budget stays predictable year over year.
Why BCS Financial
- Decades of specialty insurance experience serving Blue Cross and Blue Shield plans and beyond.
- Complete array of coverage options for both large and small self-funded groups, including specific, aggregate, reinsurance, risk share, and under-writing only arrangements.
- Products underwritten by BCS Insurance Company and 4 Ever Life Insurance Company.
- Integrated cost containment partnerships, not just risk transfer.
Stop Loss Insurance FAQs
Stop loss insurance protects self-funded employers from catastrophic claims by capping the amount the plan pays out, either for an individual claimant (specific) or across the group (aggregate).
Specific stop loss caps the cost of an individual high-cost claimant. Aggregate stop loss caps the plan’s total claims cost across the group for the year.
Coverage levels depend on group size, claims history, and risk tolerance. BCS works with your broker to structure specific and aggregate limits that fit your plan.
Reinsurance and risk share arrangements let BCS share stop loss risk with health plans and carriers, spreading exposure to catastrophic claims across multiple parties.
Yes. Specific stop loss caps exposure to any high-cost claim, including gene therapies and specialty drugs. BCS also offers gene-therapy-only Stop Loss GT/GTS for additional, dedicated protection.
Protect Your Plan Before the Next High-Cost Claim
Talk with a BCS specialist about specific, aggregate, reinsurance, and cost containment options for your organization.
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Stop Loss Insights & Resources
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Gene Therapy, Speciality Drugs, and Million-Dollar Claims: What Brokers Need to Know About Self-Funded Risk
Over the past decade, BCS has seen an 850% increase in the number of claims exceeding $3 million, driven by gene therapies, specialty drug spend, and rising high-cost claimants across rare disease, neonatal, oncology, and complex cardiac care. These multi-million dollar treatments are now common across the industry, and contributing to rising loss ratios and…