Stop Loss Insurance

NexgenRx  , in conjunction with ETFS  , is pleased to offer Canada’s leading health services "stop loss insurance" products, insured by Royal & SunAlliance Insurance Company of Canada. These products enable small (minimum 25 lives), medium and large plan sponsors to enjoy substantial savings by self-insuring their health benefit plans under Administrative Services Only (ASO) contracts with NexgenRx.

Stop Loss Insurance limits the plan sponsor’s liability for claims for any individual or the group as a whole to an affordable level of risk. Protection can be provided against excessive losses for Drug expenses only or for Drug and Extended Health Care expenses combined.

Individual Stop Loss (Pooled Coverage) 
Individual Stop Loss limits the plan sponsor’s liability for each primary or dependant member covered under the plan to a predetermined amount selected by the sponsor. These limits, called attachment points, can be chosen in the following amounts: $3,000, $5,000, $7,500, $10,000, $15,000, $20,000 or $25,000.

Under pooled coverage, recurring claims will be covered without fear of losing coverage or having the attachment point increased beyond reason in the following year for the same claimant. Statistics show once an individual incurs drug and/or medical expenses above the attachment point in any one year, there is a high probability that claims will recur at the same level or above in following years.

Aggregate Stop Loss 
Aggregate Stop Loss is written in conjunction with Individual Stop Loss but provides added protection against overall losses at the group level. Plan Sponsors can elect to limit their liability for all Drug and Extended Health Care benefit payments to a predetermined amount expressed either as a dollar amount or percentage of expected claims in a given year.

Generally, the aggregate stop-loss level can be no lower than 125% of expected claims. As Health and Drug claims are highly predictable for larger groups, this coverage will appeal primarily to the truly risk adverse plan sponsor.

Note: Premiums are quoted as a percentage of paid claims and all groups electing Individual Stop-Loss are eligible for standard rating. Rates for aggregate stop-loss must be quoted by ETFS   head office.