Frequently Asked Questions

Explore our list of common questions and answers about our stop-loss insurance supplement.

When is the Benefit Period?

The benefit period for stop-loss coverage is January 1st through December 31st. Self-insured employers may elect to join at any point during the year. There is no retro-payment required and no benefit for any period prior to enrollment.

How Does Coverage Work?

Participation in the Captive requires prescription benefit coverage through RxBenefits, the adoption of RxBenefits’ Clinical Advantage Program (CAP), Specialty Pharmacy coverage and Specialty fulfillment through an approved pharmacy.

New to plan members with pre-existing conditions AND members who are newly diagnosed are eligible for stop-loss coverage. Once an eligible member reaches a plan cost of $250,000, the plan is entitled to reimbursement of qualified expenses up to the limits of the policy—$1,000,000 annually; $3,000,000 lifetime.

Employers that remain continuously enrolled will continue to receive benefits in subsequent years for those members that are new to plan or newly diagnosed after the initial enrollment date, up to the limits of the policy.

Is This an RxBenefits Product?

No. RxPharmacy Assurance is a wholly owned subsidiary of RxBenefits; however, it is a separate entity licensed to operate within the State of Vermont in conjunction with Marsh Captive Management.

What Does Supplemental Prescription Stop-Loss Cover?

Our supplemental stop-loss coverage applies to specialty prescription therapies that are used to treat more than 36 conditions.

What is the Cost in 2022?

There is a one-time fee of $1.00 for the self-insured employer to enroll in the Captive. Monthly, the fee is $1.35 PMPM. Premiums will be based on average member count and will be billed on the 1st of each month. Continuous coverage is based on payment of the established premium.

How Do I Get Started?

Interested insurance brokers can request broker certification information via the RxPharmacy Assurance website. Contact us by filling out the form below.

Reimagine
Pharmacy Risk

Contact us to learn how joining RxPharmacy Assurance can help best-in-class companies secure affordable pharmacy-specific supplemental stop-loss insurance to offset the volatility of the traditional Stop-Loss insurance market.

463 Mountain View Drive
Suite 301
Colchester, Vermont 05446

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