Medical Excess

Medical Excess offers a fully insured, first dollar organ and tissue transplant carve out for self funded groups. This remarkable benefit is encompassed in an admitted stand alone policy that can attach to any plan document, regardless of the stop loss carrier. The coverage begins at patient evaluation and extends 365 days post transplant operation, and pays 100% of all covered transplant-related physician, hospital, and drug expenses when in network. A shorter benefit period is available.

As many as 40%-50% of all lasers imposed on self funded groups are due to transplant exposures.

The average waiting time for a solid organ is over a year. As a result, transplant patients usually jump over stop loss contract years, thus becoming magnets for imposed lasers or rate increases.

SMALL SELF-FUNDED GROUPS GENERALLY CANNOT INTERNALLY FUND A TRANSPLANT EXPOSURE AS ECONOMICALLY OR EFFICIENTLY AS THROUGH OUR CARVE OUT POLICY.

100% coverage on all major transplant types from first dollar to $1 million life maximum

100% coverage for NCI Phase Trials III and IV for adults, Phases I through IV for pediatrics (this is a much more liberal coverage of experimental than most plan documents allow)

No deductibles for patients when in-network

Liberal expense allocations for patients traveling to distant centers of excellence

Benefit period covers from time of patient evaluation through 365 days post transplant, and includes hospital, physician and pharmaceutical expenses

Direct payment by Medical Excess to providers, no cash flow issues for the employer

Complete medical management and coordination of the patient with on-staff RNs

Average cost of about $8.00 PEPM, a far less expense than the cost of a laser

Contributes budget predictability and stability to stop loss rates

Bone Marrow Heart Heart/Lung Intestine Kidney

Kidney/Pancreas Liver Lung Pancreas Stem Cell

Up to 10% commission

Many stop loss carriers give a 2% to 10% credit on the specific stop loss for the transplant carve out, based on stop loss specific deductible

TPA Partners are waived of group minimum size, thus becoming a competitive differential for groups looking for this coverage

Extensive marketing assistance afforded to the producer from Medical Excess to help sell the program

A group can be eligible for this coverage regardless of their stop loss carrier, as long as they meet minimum enrollment requirements

High renewal persistency among groups with transplant carve out

Medical Excess management of transplant exposures allows administrator to redirect internal clinical resources to more chronic problems

Unions and Associations often cap transplants at 250K and less, rendering it a less valuable benefit.

Large, completely self funded groups. Many don't want to sustain a single catastrophic hit such as Transplants and may have a high frequency issue.

Groups that have experienced a transplant exposure in the past or groups where a laser has played havoc with their stop loss insurance.

Groups that "have never had a transplant exposure". The best time to buy transplant insurance is when the group is completely clean of exposures.