Administrative Services Only (ASO) and Stop Loss

Self Assure Level Funding

Self Assure Level Funding is intended for small and mid-sized employers that want the benefits of self-funding, but predictability as well. UPMC Self Assure is a level-funded arrangement for groups with 10 enrolled and up to 199 eligible employees. Self Assure Level Funding is an ASO arrangement and employers who choose this product pay a fixed monthly amount based on the year's expected claims, plus fixed costs. There are no hidden charges or carryover to the next year. Employers receive protection from high-cost claimants and can receive a claim refund if their claims are lower than expected.

Stop Loss Insurance

UPMC Health Benefits provides stop loss coverage options for self-funded groups with 100 or more eligible employees. When you choose UPMC Health Plan stop loss coverage for your business, we safeguard your health care dollars as carefully as we do when our own money is at risk. We monitor all aspects of the health care process, starting with the initial claim to potential high payouts, ensuring accuracy and data security the whole way.  No more chasing vendors, data is automatically added to your reporting allowing you to make informed decisions quickly.

Stop loss insurance can protect your company from unexpected high claims. Our stop loss coverage is offered on both a specific (individual) and aggregate (all members) basis:

• Specific stop loss: Covers you when a specific member has a catastrophic illness or injury with extremely high medical bills. Once an individual’s claims exceed a predetermined amount—called the specific deductible—the stop loss insurance reimburses the employer for the excess.
• Aggregate stop loss: This coverage protects your business from unusually high total claims across the entire group. If the total claims for all covered individuals exceed a certain threshold—called the aggregate attachment point—the stop loss insurance reimburses the employer for the excess.

Why choose UPMC Health Plan stop loss coverage?

• One carrier, one contact: Combining your Administrative Services Only (ASO) plan with stop loss coverage through UPMC Health Plan simplifies communication and administration.
• Data security: One carrier means your data is safely held 100% of the time.
• Data sharing: No more chasing vendors, data is automatically added to your reporting.
• Bundled pricing: Discounts can be offered for total replacement ASO and stop loss clients.