Participation & Eligibility
This is the smallest size group we like to write.
What is 50 Employees?
Don't confuse this type of group with the sound a cat makes?
What is a MEWA?
Run, don't walk, away from this contract basis type.
What is a 12/24?
Renewal increases under this threshold can qualify.
What is 30%?
High Risk Dx's that require Brad's approval are referred to by this color.
What is RED?
This state, home to Starbucks, presents the most regulatory challenges to Underwriting.
What is Washington State?
Before a Plan considers allowing trips down to Mexico for cosmetic procedures, it may want to amend this exclusion to the stop loss policy.
What is # 14 - amounts Paid for treatments administered outside of the United States.
RBP generally benchmarks claim cost to this standard fee schedule.
What is Medicare Allowable?
This Tiny Dancer has led us in company cheers on more than 1 occassion.
Who is Ashley Geissenhainer?
ESL UWs live and die by this metric.
What is RTM?
This acronym refers to a higher risk group of participants in a Plan.
What is "COBRA"?
Hospitals that want high %s of this contract feature may be considered "Sus" by Gen Z.
What is domestic reimbursement?
We discount short contracts for CRI by this amount.
What is 2%?
Initial underwriting scenarios should always be run on this contract basis.
What is a 12/15?
This type of reporting is not meant to make us "gun shy" but can help us set better lasers.
What is "trigger" reporting.
IMO, this product feature is not necessary for most groups that have self-funded for a long time.
What is TLO (Terminal Liability).
This is the grace period for payment of premium provisions.
What is 31 days from the due date for each premium after the first premium payment.
This term refers to contracts outside the RBP allowable.
What are SCAs - Single Case Agreements.
This environmental phenomenon put a damper on our 2023 NSM in Sanibel, giving a whole new meaning to "swimming with the fishes".
What is the "red tide"?
Sometimes referred to as brokers' brokers, these 3 GAs are among our largest relationships in ESL.
Who are Stealth, CRC Benefits, and SBR?
Not to be mistaken with an 80s Madonna hit, we should take caution with this type of group?
What is a Virgin group?
This group type typically requires Special Limitation language.
What are tribal groups?
Not to be confused with a dental situation, this contract type can help bridge runout contracts.
What is a gapless contract?
This is the minimum aggregate attachment for Market Based Groups.
What is a 120% attachment?
This homegrown acronym represents the $$ value of ongoing claim liability.
This is our policy's standard fee allowance for % of savings (be specific).
What is 25% of the amount saved, not to exceed $25,000 or 75% of the amount paid to the provider?
The policy can terminate if the number of covered persons under the Plan falls below this % of eligible employees.
What is 75%?
This special limitation provision provides us protection for large claims where providers may not accept RBP.
What is "Any single case agreement (SCA) negotiated outside the standard reference-based pricing benchmark that results in an expected claim payment in excess of 200% of Medicare, where the billed charges are also in excess of $50,000, requires advanced approval from the Company in order to be eligible for consideration under this policy".
Not to be confused with a DCC Cheerleader, this legacy UW demonstrated her jump-split skills at the 2024 San Antonio NSM.
Who is Wendy Broadrick?
Not to be confused with the 90s west coast rapper TUPAC, this term refers to ESL's version of CCAP.
What is BPAC?
Unfortunately for Bad Bunny's family, we cannot write groups with this situs.
What is Puerto Rico?
A monthly enrollment change of this % (up or down) can trigger re-underwriting.
What is 15%?
This contract basis with bonus feature is often used for 1st year fully insured takeovers.
What is a 12/12 with TLO.
Use this part of the Market Based calc to get more aggressive.
What is the Goal Seek scenario?
These three Dx categories will always require Brad's approval.
D59 Hemolytic anemia, D66-D68 Coagulation defects, and D84 Disorders involving the immune system
What is the Aggregating Specific Deductible?
Policy alignment, not to be confused with mirroring, is extended by including these three endorsements to the stop loss policy.
What are Experimental/Investigational Services Endorsement, Exclusions Endorsement, and Actively at Work Endorsement.
These types of fees are not covered under stop loss for RBP vendors.
What are PEPM or fixed fees (not % of savings).
This song, often making an appearance late night at NSM, is a Zimmerman/Sollosi classic.
What is "Ice Ice Baby"?
ESL underwriters can't price for this common feature in Duplicate scenarios.
What is an override?
Our guidelines say that we should be cautious if plan participation is less than this % of eligible employees, to avoid this type of exposure.
What is 60%, to avoid "adverse selection"?
This policy feature allows us to recalculate aggregate factors based on the last 2 months of prior year reporting.
What is if the differential between the average monthly Paid claims under the Plan for the last 2 months of the prior Policy Period is more than 15%, compared to the average monthly Paid claims under the Plan for the first 10 months of the prior Policy Period?
This contract basis and 1st renewal contract basis should be used for CaptureRe new biz fully insured takeovers.
This tool should be used to derive impact of moving PPO to RBP when using MB calc, and this is the maximum % credit we should give to the agg.
What is the RBP calculator and what is 8%?
This song helped launch Jim Sollosi's singing career at the 2025 UW Leadership offsit meeting.
What is "Underwritingville"?
This 1990s Bill Murray spurred a nickname for one of very own Sales Reps.
What is "What About Bob"?
Claims eligible under more than one policy years must be filed under this one.
What is the earliest Policy Year under which the claim is eligible.
This plan strategy is trending to give more choice to employees when the Employer offers RBP.
What is "Dual Option"?
This Analyst introduced us to a trendy skincare routine in Tampa, earning him this beloved nickname.
Who is Adam Vanotti - aka "Beef"?
This policy feature can be used to sell a similar value proposition to Captives.
What is Experience Rewards / Refund?
Our clinical underwriting team (with Jack's help) reports that these are the average laser hit rates in EmCap and ESL respectively, and this third percentage is the average laser precision rate for both.
What are 36%, 50%, and 70%.