Berkley Accident and Health improves Medical Stop Loss protection

“> , a Berkeley company, has added a new benefit to its Medical Stop Loss coverage to help companies better manage medical costs associated with the No Surprises Act. The benefit provides additional support to employers who self-fund their benefit plans in navigating the complexities of the No Surprises Act.

The No Surprises Act (NSA), passed by Congress in 2020, created new consumer protections against surprise medical bills and balances. Surprise medical bills can arise when patients are inadvertently treated by out-of-network hospitals and doctors they did not choose, such as radiologists or anesthesiologists. An estimated one in five emergency room visits are by an out-of-network doctor.

“We are expanding our medical stop-loss coverage to better protect our customers and maintain our commitment to making self-funding more accessible and predictable. The No Surprises Act has been a win for patients by eliminating most surprise medical bills and getting patients out of network billing disputes,” Nieland continued. “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 coverage year, it could mean additional liability for employers 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 companies pay their own medical expenses rather than purchasing health insurance. This means that a large portion of U.S. companies could face additional financial risk as a result of the No Surprises Act.

Berkley Accident and Health offers its Independent Dispute Resolution (IDR) endorsement at no charge to all new and current stop-loss policyholders and members of its EmCap group programs. If negotiations with third parties for an out-of-network claim begin in a 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.