Risk Management & Stop-Loss
Protecting against catastrophic costs
Stop-loss insurance and risk management strategies that protect self-funded employers from excessive claims
Why does risk management matter for health benefits?
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Self-funded and level-funded plans expose employers to claims risk. A single catastrophic claim can exceed what smaller employers budgeted for an entire year. Risk management strategies—especially stop-loss insurance—protect employers from financial catastrophe while preserving self-funding benefits.
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See where your benefit plan is leaking
Find out what gaps exist — and what you can do without changing your plan.
We'll show you where money is leaking, risks are growing, and what you can fix within your current structure. No pressure to change brokers, carriers, or benefit design. Just clarity.
- Gap analysis based on your actual plan structure
- Clear findings you can share with your broker
- Recommendations that layer on — no disruption required
Stop-Loss Placement
Securing appropriate stop-loss coverage that provides protection at the right levels without overpaying for unnecessary coverage.
Specific Stop-Loss Strategy
Individual claim protection that limits exposure from any single catastrophic claimant.
Aggregate Stop-Loss Planning
Total claims protection that limits exposure when overall claims exceed expectations.
Risk Assessment & Monitoring
Ongoing evaluation of risk exposure and claims patterns to optimize protection and identify emerging risks.
What is Risk Management & Stop-Loss?
Risk Management & Stop-Loss encompasses strategies and insurance products that protect self-funded employers from excessive healthcare claims.
Self-funding means employers pay claims directly rather than paying fixed premiums to insurers. This creates savings opportunity but also risk—claims can vary significantly from expectations.
Stop-loss insurance provides protection: specific stop-loss covers individual large claims; aggregate stop-loss covers total claims exceeding expectations. Proper risk management ensures employers capture self-funding benefits while limiting downside exposure.
Why Can't Self-Funded Employers Just Accept Risk?
Most employers renew their health plans year after year without questioning the underlying assumptions. Brokers present options, carriers set rates, and leadership approves budgets based on incomplete information.
The result? Companies overpay for benefits employees don't use while missing coverage gaps that create real risk. They accept premium increases as inevitable rather than addressable. They lack visibility into where their money actually goes.
A Healthcare Risk Assessment changes that. It gives you the data and insight to make informed decisions, negotiate from a position of strength, and take control of one of your largest operating expenses.
How It Works
Risk management protects employers while preserving self-funding benefits.
Risk Assessment
Evaluating your claims history, population characteristics, and risk tolerance to determine appropriate protection levels.
Stop-Loss Design
Designing stop-loss coverage: specific deductible levels, aggregate attachment points, and policy terms that match your risk profile.
Ongoing Management
Monitoring claims, managing stop-loss recoveries, and adjusting protection as circumstances change.
When Is Stop-Loss Protection Needed?
Stop-loss is essential for:
• Self-funded employers of any size
• Level-funded arrangements (often included)
• Group captive participants
• Any employer bearing claims risk
The only employers who don't need stop-loss are those large enough to fully self-insure all risk—typically 10,000+ employees.
Where Does Stop-Loss Apply?
Stop-loss protects against excessive claims from:
• Medical claims (the primary exposure)
• Prescription drug claims (increasingly significant)
• Sometimes integrated with other coverages
• Both specific individual claims and aggregate total claims
Who Needs Risk Management Support?
Employers with claims risk exposure:
• Self-funded employers
• Those considering self-funding
• Level-funded employers wanting to understand their protection
• Any employer bearing some claims risk
See What Our Customers Are Saying
"What could have been data driven, was soon a conversation. Over 3 years with the best coaches, listeners, advisors you could ask for. If Monique didn't have an answer readily, she would note it, research it, and then update you on the answer. Always a positive meeting. Highly recommend!"
— Sue D.
“Our Medical Insurance Premiums were Out of Control! Thanks to Weltrio and their amazing team of healthcare experts, Weltrio is my single most-profitable cost center!”
— Cayuse CEO
Everything You Need to Know
At Weltrio, we are a medically trained team that works with HR and benefits partners at companies of all sizes to improve healthcare quality, reduce risk exposure, and optimize costs. We work within your existing plan structure—providing employers with clarity, trust, and transparency at every step. Whether you're upgrading your benefits plan or building from scratch, we've got you covered.
Is this the same as telemedicine?
No. Clinical support provides guidance and triage, not diagnosis or treatment. We help employees decide when and where to seek care.How many nurses will be assigned to our company?
Assignment depends on your company size and typical utilization. Smaller companies may share a primary nurse with backup coverage. Larger organizations get dedicated teams. Either way, employees experience consistent relationships with clinical professionals who know them.Who answers calls in the middle of the night?
Board-certified nurses from your Weltrio clinical team. We staff night shifts with experienced nurses who have full access to your company's benefits information and employee interaction history. It's not an outsourced answering service.What protocols do nurses use for triage?
Our nurses use evidence-based clinical decision support protocols developed from emergency medicine and primary care best practices. These protocols are regularly updated based on current medical guidelines and are customized for telephone/virtual assessment settings.How much does an unnecessary ER visit actually cost?
Average ER visits cost $2,200 or more—even for minor issues. Add lab work, imaging, or specialist consultation and costs climb quickly. The same conditions treated at urgent care typically cost $150-300, and telehealth visits run $50-75.
