About Us

Advisory #3: Patient Protection & Affordable Care Act: Focus on Stop Loss

Message from HM Insurance Group President & COO Mike Sullivan

PITTSBURGH – (June 10, 2010) – HM Insurance Group is offering unlimited lifetime maximum Stop Loss coverage for self-funded groups to help employers meet the mandates of the recently enacted Patient Protection and Affordable Care Act (PPACA). Effective immediately, new and renewal* policies can be written with an unlimited lifetime maximum and no annual maximum, subject to state regulatory approvals. The elimination of coverage limits makes HM Insurance Group among the first of the leading Stop Loss carriers to issue policies that meet or exceed these critical PPACA mandates in advance of the required date for changes.

Two other significant mandates affecting Stop Loss will have no impact on rates. HM will provide dependent coverage to age 26 and will accept employer plan documents that include the waiving of pre-existing condition limitations.

Additionally, HM has evaluated the requirements for the “Reinsurance for Early Retirees” program and has determined that for its self-funded policyholders, Stop Loss is separate and distinct from any reimbursement an employer is eligible for under the fund established by the PPACA. Therefore, we will not take into account or in any way change the way we currently pay qualified claims for policyholders with eligible retirees, thus avoiding additional administration and benefitting our policyholders.

We strive to be responsive to our producers and their clients by working collaboratively to find appropriate health risk solutions. I believe we can offer plan designs with an unparalleled degree of flexibility that combine the employers’ risk tolerance with cost-effective approaches. HM can work with you to design Stop Loss coverage with various  deductible intervals and reimbursement amounts up to and including unlimited maximums to help you and your clients achieve the optimal level of coverage that meets the PPACA requirements.

* This will be available for renewal policies immediately upon the policy anniversary.