Berkley Accident and Health enhances Medical Stop Loss protection

Berkley Accident and Health , a Berkley Company, has expanded its Medical Stop Loss coverage with a new benefit designed to help companies better manage medical costs related to the No Surprises Act. The benefit provides added support to employers that self-fund their benefit plans as they navigate the complexities of the No Surprises Act.

The No Surprises Act (NSA), passed by Congress in 2020, established new consumer protections against surprise medical bills and balance billing. Surprise medical bills can occur when patients inadvertently receive care from out-of-network hospitals and doctors they did not choose, such as radiologists or anesthesiologists. It is estimated that 1 in every 5 emergency room visits results in out-of-network care.

“We’re expanding our medical stop loss coverage in an effort to provide superior protection to our customers and maintain our commitment to making self-funding more accessible and predictable. The No Surprises Act was a win for patients because it eliminates most surprise medical bills and gets patients ‘out of the middle’ of network billing disputes,” continued Nieland. “However, the NSA also requires out-of-network providers and payers, such as self-funded health plans, to negotiate a fair payment amount through independent dispute resolution.” – Brad Nieland, President and CEO.

This arbitration process can take weeks or months. If the process extends into a new Stop Loss policy year, that could expose employers to added liability and a potential gap in Stop Loss coverage. According to the Kaiser Family Foundation, 65% of covered workers in the U.S. are enrolled in a self-funded plan, where firms pay their own medical claims, rather than purchase health insurance. This means a large portion of U.S. firms could face additional financial exposure from the No Surprises Act.

Berkley Accident and Health is offering its Independent Dispute Resolution (IDR) endorsement to all new and current Stop Loss policyholders and members of its EmCap group captive programs at no additional cost. If third-party negotiations for an out-of-network claim begin in one Stop Loss policy year and extend into a second policy year, the IDR endorsement fills the gap with Specific Stop Loss run-in protection. The Independent Dispute Resolution endorsement is available in all 50 states and the District of Columbia.