The AUL Stop Loss Policy Q&A
Am I purchasing coverage through an MGU or a direct-writer?
Direct-Writer! R.E. Moulton and American United Life Insurance Company® (AUL) are part of the OneAmerica family of companies. The R.E. Moulton staff are all employees of the companies of OneAmerica, creating a direct affiliation between the underwriting and insuring entity, AUL.
How will experimental and investigational claims be defined by the AUL Policy?
We recognize that any inconsistency between the health plan and the stop loss policy in the emerging areas of experimental and investigational treatment can result in significant liability gaps for your employer groups. With the AUL's stop loss insurance policy from R.E. Moulton, the language is clear and consistent.
The AUL policy does not exclude reimbursement for E&I claims. The AUL policy is straight forward when it comes to the challenges listed above: it follows the language within the plan document to help determine when any of the following related claims are eligible for reimbursement:
- Experimental and Investigational procedures
- Clinical trials
- Off-label drug use
- Never events
- New treatment or setting of care trends
Does AUL cede any of its stop loss risk with other reinsurers?
AUL does not participate in any reinsurance for the quota share of its current specific stop loss insurance product administered by R.E. Moulton, demonstrating a true commitment to this line of coverage. This risk arrangement also means that R.E. Moulton maintains a high level of flexibility in its underwriting practices consistent with our entrepreneurial philosophy of tailoring insurance products to meet unique needs and special risks.
Does the AUL Policy impose any financial run-in limitations on its specific or aggregate contracts?
No.
Is the AUL Policy specific reimbursement maximum reduced by the specific deductible?
No. While other stop loss policy maximum reimbursement levels are further reduced by the stop loss specific deductible (i.e. the reimbursement maximum), the AUL maximum specific is also the maximum reimbursement level.
