Understanding the Industry

 

At ATS Underwriting, our goal is to bring clarity, transparency, and education to the self-funded stop loss industry. This Resource Center is designed to help brokers, TPAs, and employers stay informed, confident, and prepared in a rapidly evolving market.

Here, you’ll find everything you need to navigate today’s funding environment, including market insights, downloadable guides, FAQs, and a complete glossary of key terms. Whether you're new to self-funding or looking to deepen your expertise, this page serves as your central hub for trusted information.

RFP Checklist

2026 ATSU Market Insights

RFP Coversheet Template

Self-Funded in the News

Medical Stop Loss Claims Trends: Million-Dollar Cases Double as Cancer Remains Dominant

QBE reports that medical stop-loss claims are increasing, with cancer, blood disorders, and circulatory diseases driving higher costs. Million-dollar claims have doubled over four years, fueled by expensive treatments like CAR-T therapy and early-onset cancers in younger populations. Preterm births and specialty pharmacy therapies are adding further financial strain, highlighting the need for employers to manage risk and tailor coverage.

Stop loss shake-up: what's next for the shifting market?

Stop-loss insurance is facing growing risk as large medical claims surge, with premiums rising steadily but claims over $2 million becoming more frequent. Employers are advised to carefully vet carriers, review policy terms, manage claims data, and work with experienced brokers to control costs and ensure adequate coverage.

Brokers blast CT bill imposing mandates on self-funded employer health plans

Senate Bill 10 would impose mandates on self-funded, employer-sponsored health plans, raising employer liability and healthcare costs. Businesses and brokers warn it could force small employers to drop coverage, switch to fully insured plans, or push employees to the individual market, while critics say it threatens level-funded plans with stop-loss insurance by imposing a rigid, one-size-fits-all approach that limits flexibility.

As healthcare costs rise, more small employers are turning to level funded plans

Employer health insurance costs are expected to rise more than 9% in 2026, hitting small businesses especially hard. To manage rising premiums while still offering competitive benefits, many small employers are turning to level funded health plans, which provide predictable monthly costs and potential savings if claims are low. Adoption of these plans has grown rapidly as businesses look for more flexible, cost-conscious alternatives to traditional coverage.

FAQs

STOP LOSS & LEVEL FUNDED

What is medical stop loss insurance?

Medical stop loss insurance protects self-funded employers from unexpected or high-cost medical claims. It reimburses the employer once claims exceed a predetermined limit.

What is the difference between specific and aggregate stop loss coverage?

Specific coverage protects against high-cost claims from a single individual, while aggregate coverage protects the overall plan if total claims exceed expectations.

What is a level funded plan?

A level funded plan blends fixed monthly payments with self-funded components. Employers pay a predictable monthly amount that covers claims funding, administrative fees, and stop loss insurance.

Who is a good fit for level funding?

Small to mid-sized employers that want the cost control of self-funding but prefer predictable monthly budgeting often benefit from level funded plans.

Why are stop loss rates increasing across the industry?

Pricing is influenced by rising claim severity, specialty pharmacy trends, high-cost therapies, and shifting market risk. ATS provides regular market updates to help clients stay informed.

How does ATS support brokers and TPAs during the quoting process?

We provide responsive underwriting, clear assumptions, and guidance on plan design details that may impact pricing or risk.

What information is required for a stop loss quote?

Census data, prior claims information, plan designs, and any critical health disclosures are required. Our RFP Submission Checklist outlines the full list.

Does ATS offer marketing or client-facing materials for brokers?

Yes. We offer downloadable guides, educational resources, product overviews, and onbarding materials upon request. 

How quickly can brokers expect a quote?

Turnaround time varies depending on case complexity, but most standard submissions are reviewed within 24–72 hours.

Can ATS assist with renewal strategy and conversations?

Absolutely. Our underwriting team partners closely with brokers to explain renewals, identify trends, and support client education.

What are the benefits of moving to a self-funded or level funded plan?

Employers gain more control over plan design, potential cost savings, access to claims data, and greater flexibility in managing benefits.

CLAIMS

What happens when claims are lower than expected?

Depending on the product structure, employers may receive a refund or credit of unused claim funds. In level funded plans, this is often returned at the end of the plan year.

What happens when claims are higher than expected?

If claims exceed the employer’s funding level, stop loss coverage activates according to the policy terms to protect against excessive costs.

Do employers still have access to claims reporting?

Yes. Self-funded and level funded clients receive regular reporting through their TPA, offering transparency into health plan performance.

Do employees notice a difference between fully insured and self-funded plans?

Generally, employees do not experience noticeable differences unless the employer makes changes to benefits or network structure.

How do I submit a stop loss claim?

Claims are submitted through your TPA following their standard process. The TPA coordinates directly with ATS for reimbursement review.

How long does the reimbursement process take?

While timelines vary by case complexity, most claims are reviewed promptly when complete documentation is provided.

What documentation is required for a stop loss claim?

Common requirements include itemized bills, diagnosis codes, proof of payment, and medical records. Our “Understanding Your Claim” guide provides a full overview.

What types of claims are eligible for stop loss reimbursement?

Claims must be covered under the employer’s health plan and fall within the specific or aggregate contract terms.

Can employers track the status of a stop loss claim?

Yes. Employers can work with their broker or TPA to monitor claim progress and request updates during review.