Frequently Asked Questions
MGU Name
RMTS, LLC
dba RMTS Insurance Services, LLC in CA and AR
Who are your Carriers and how long have you worked with them?
Trustmark—1986 to Present
Gerber—1991 to Present
Nationwide—2005 to Present
New York Life (Group Life and AD&D) 2003 to Present
AM Best Rating of Carriers, respectively A-, A, A+, A++
Specific Contract
What benefits does the specific reinsurance contract cover?
Med, Rx and Dental, Vision and STD if requested
Is advance funding available on the specific?
Yes.
What is the fee?
3%
What is the initial funding corridor?
10,000
What limitations do you have on the last month?
Advance Funding not Available.
What individual lifetime maximums do you provide?
Up to $5 million.
Do you “laser” at renewal?
We will offer quote with and without laser options.
Do you have run-in limits on your specific deductibles?
Waived with receipt and review of paid, pending and precert reports.
Is there a minimum annual premium required?
No.
Are the specific rates quoted “firm”?
Yes.
If there is a catastrophic claim, will you not renew?
No.
Do you have a maximum increase on the specific rates?
No.
What is your minimum specific deductible available?
25,000
Aggregate Contract
What benefits are covered by the aggregate reinsurance contract?
Same as Spec.
Is monthly accommodation available?
No.
Do you require an aggregate run-in claim limit?
Yes, 15% of the MAP unless waived
What is your aggregate premium payment mode?
Annually, Monthly or PEPM
Is there a discount if paid annually up front?
Yes. 20% Discount
Do you have a minimum aggregate premium required?
No.
Is there a minimum aggregate attachment point?
Yes. 100% of the attachment point.
How do you calculate it?
Calculated using the census as of the effective date.
What is the aggregate maximum reimbursement in your contract?
1,000,000
What is required to guarantee the aggregate attachment factors?
12th month of claims
How far in advance are the factors considered firm?
30 days on renewals only
Coverage and Provisions
Do you offer Aggregate Terminal Liability coverage?
Yes.
Do you offer Specific Terminal Liability coverage?
No.
What is the maximum length available?
3 months
What is the additional premium charge?
$5,000 Up front lump sum payment.
Does your TLO automatically activate at termination?
No. Policy holder must notify carrier within 30 days of effective date that coverage will not be renewed.
What is the adjustment to the aggregate factors for the TLO liability?
18%–Nationwide and Trustmark, 35% Gerber.
Do you waive the Actively At Work provision?
Yes, if conditions are satisfied.
Do you have an organ transplant benefit max or limitation?
We will require as per plan document.
Do you have mental/nervous benefit plan requirements?
We will cover as per plan document.
When is your renewal guaranteed not to change?
Renewal rates are firm.
Is a signed disclosure statement required for new business? If yes, how far in advance can it be completed?
Yes. 30-45 days.
Is a signed disclosure statement required for your renewals?If yes, how far in advance can it be completed?
Yes. 30-45 days, subject to update.
Do you perform phone APS’s?
Yes, with approval from the TPA. Our consulting physician will speak with physicians or case managers.
What is your minimum number of ee lives for a group?
50ee lives.
Will you “non-renew” if the group size falls below the minimum?
No, unless state law requires non-renewal.
Claims and Reimbursement
Do you reimburse case management fees?
The following fees related to otherwise eligible claims are covered under the stop loss policy subject to the limits set forth below:
Case management fees that are billed on a percentage of negotiated savings are reimbursable at the lesser of the amount billed by the case management vendor or 30% of the savings generated.
Case management fees based on hourly billings are reimbursable up to $3,000 per claimant per year. Fees billed in excess of $3000 will be considered provided actual savings can be demonstrated and to the extent that such fees do not exceed 30% of the savings generated.
Negotiation, secondary network and reasonable and customary reviews are eligible for specific stop loss reimbursement up to a maximum of 30% of savings.
What is your current reimbursement time average for specific claims?
Claims are reviewed within 15 days of submission.
What is your current reimbursement time average for aggregate claims?
No statistics are available. If an aggregate audit is conducted reimbursement is made at the audit’s conclusion.
Are there any industries you do not quote?
We will consider all industries.
Do you reimburse domestic claims?
Varies.
How long after premium is due do you allow payment?
30 day grace period.
