Score stop-loss contracts across 35 provisions including laser language, run-in/run-out, margin transparency, and pooling terms to prevent hidden carrier profits
Your stop-loss carrier quoted a "competitive" $125 specific deductible with 12/12 coverage. Looks standard. Then a $2.8M cancer claim hits in month 11. Carrier denies: "Run-in period applies—claim incurred before contract start." Your actuary reviews the contract: pooling charges retroactively increased premium by 18% over three years. That "competitive" contract cost you $3.1M in hidden carrier profit.
Our Stop-Loss Contract Scoring Engine evaluates agreements across 35 critical provisions (deductible levels, laser language, pooling charges, run-in/run-out, margin transparency, terminal liability), scores each provision 0-100, identifies unfavorable terms, and generates negotiation recommendations.
Stop-Loss Contract Scoring Algorithm// 35-point stop-loss contract evaluation CONTRACT_PROVISIONS = [ deductible_structure, laser_provisions, pooling_charges, run_in_run_out, margin_transparency, terminal_liability, claim_administration ] FOR each provision IN CONTRACT_PROVISIONS: // Deductible Structure (6 provisions) IF provision == deductible_structure: SCORE: - Specific deductible competitive? (15 pts) - Aggregate corridor reasonable? (15 pts) - Contract basis (12/12 vs 15/12)? (15 pts) - Deductible stacking prohibited? (15 pts) - Family vs individual aggregation clear? (20 pts) - Lifetime maximum adequate? (20 pts) // Laser Provisions (7 provisions) IF provision == laser_provisions: SCORE: - Laser threshold ≥$250K? (20 pts) - 60-day advance notice required? (15 pts) - Medical justification required? (15 pts) - Laser premium formula disclosed? (15 pts) - Max laser premium cap defined? (15 pts) - Removal criteria specified? (10 pts) - Appeal rights included? (10 pts) // Pooling Charges (5 provisions) IF provision == pooling_charges: SCORE: - Pooling charge formula disclosed? (25 pts) - Historical loss ratio provided? (20 pts) - Retroactive adjustment prohibited? (25 pts) - Cap on pooling charge increase? (15 pts) - Annual transparency report required? (15 pts) // Run-In/Run-Out (4 provisions) IF provision == run_in_run_out: SCORE: - 12/12 coverage guaranteed? (30 pts) - No run-in period exclusions? (30 pts) - 12-month run-out minimum? (20 pts) - Terminal liability transferrable? (20 pts) // ... 3 more provision categories ... // Calculate composite score total_score = WEIGHTED_AVERAGE(all provisions) risk_classification = CLASSIFY: IF total_score < 55: "High Risk — unfavorable terms, renegotiate" IF 55-70: "Moderate Risk — improvements needed" IF 70-85: "Low Risk — adequate protections" IF > 85: "Optimal — best-in-class terms" // Generate negotiation strategy FOR each low_scoring_provision: IDENTIFY market_standard FROM benchmark_database CALCULATE cost_impact OF unfavorable_term PRIORITIZE BY expected_savings OUTPUT: - Overall contract score - Provision-by-provision analysis - Negotiation priority ranking - Cost impact quantification
Score your stop-loss contract across 35 provisions. Identify hidden carrier margins. Negotiate optimal terms. Turn stop-loss from a black box into a transparent, competitive bid.
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