Frequently Asked Questions

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.

Participation in the Captive requires prescription benefit coverage through RxBenefits, the adoption of RxBenefits’ Protect™, 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.

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.

Our supplemental stop-loss coverage applies to specialty prescription therapies that are used to treat a broad and comprehensive range of conditions.

There is a one-time fee of $1.00 for the self-insured employer to enroll in the Captive. Monthly, the fee is $3.40 PEPM. 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.

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