How Is My Plan Running?

Employers can track the financial performance of their plan by reviewing two key areas in the portal: the aggregate report and the stop loss filing tab. Together, these give a full picture of how claims are being managed, how much protection stop loss is providing, and what that means for future renewals.

1. Access Aggregate Reporting

  • Log in to the portal.
  • Click the Reports tab on the left side of the screen.
  • Select the Aggregate Report.

2. Review the Loss Ratio

  • Download the latest version of the aggregate report.
  • Scroll to the YTD Loss Ratio column for the current month.

Interpreting the Loss Ratio (Claims ÷ Employer Funding):

  • 70–85% → Healthy. Claims are being paid without overfunding, sustainable for the long run.
  • Below 70% → Employer may be over-funded relative to actual claims.
  • Above 85–90% → Indicates higher-than-expected claims pressure; may put renewal costs under pressure.

3. Review Stop Loss Activity

  • In the portal, click the Stop Loss Filing tab.
  • Review how much has been filed with and reimbursed by the stop loss carrier.
  • Compare reimbursements to the fixed stop loss premium paid.

Interpreting Stop Loss Performance (Reimbursements ÷ Premiums Paid):

  • 0–50% → Good performance for renewal. Carrier is profitable, renewals usually stable.
  • 50–100% → Neutral. Carrier breaks even, expect trend increases but nothing extreme.
  • Over 100% → Carrier lost money on your case. Renewal increases, lasers, or deductible changes are likely.

👉 Note: Some employers may not have access to the Stop Loss Filing tab in the portal. If you would like to see this information, please contact accountmanagement@selffundhealth.com.

4. Putting It Together

  • The loss ratio shows how efficiently your plan is running against the funding set aside.
  • The stop loss performance shows how the carrier views your risk heading into renewal.

Example:

  • If your plan has a 75% loss ratio and low stop loss reimbursements, your plan is running smoothly and renewal terms should be favorable.
  • If your plan has a 95% loss ratio and stop loss reimbursements above premium, you’ve gotten value this year but should prepare for a tougher renewal discussion.

Key takeaway: To answer “How is my plan running?” you need to look at both aggregate reports and stop loss filings. Together they provide the full financial story—both for how your plan is performing today and what your stop loss renewal is likely to look like.