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Organ Transplant

Commercial Group Intermediaries offers a fully insured, first dollar organ and tissue transplant carve out for self funded groups. This remarkable benefit is encompassed in an admitted stand alone policy that can attach to any plan document, regardless of the stop loss carrier. The coverage begins at patient evaluation and extends 365 days post transplant operation, and pays 100% of all covered transplant-related physician, hospital, and drug expenses when in network. A shorter benefit period is available.


Did you know?

 

As many as 40%-50% of all lasers imposed on self funded groups are due to transplant exposures.

 

The average waiting time for a solid organ is over a year. As a result, transplant patients usually jump over stop loss contract years, thus becoming magnets for imposed lasers or rate increases.

 

SMALL SELF-FUNDED GROUPS GENERALLY CANNOT INTERNALLY FUND A TRANSPLANT EXPOSURE AS ECONOMICALLY OR EFFICIENTLY AS THROUGH OUR CARVE OUT POLICY.

 Benefits to the Self-Funded Employer:

 

100% coverage on all major transplant types from first dollar to $1 million life maximum.

 

100% coverage for NCI Phase Trials III and IV for adults, Phases I through IV for pediatrics (this is a much more liberal
coverage of experimental than most plan documents allow).

No deductibles for patients when in-network.

 

Liberal expense allocations for patients traveling to distant centers of excellence.

 

Benefit period covers from time of patient evaluation through 365 days post transplant, and includes hospital, physician
and pharmaceutical expenses.

 

Direct payment by Medical Excess to providers, no cash flow issues for the employer.

 

Complete medical management and coordination of the patient with on-staff RNs.

 

Average cost of about $8.00 PEPM, a far less expense than the cost of a laser.

 

Contributes budget predictability and stability to Stop Loss rates.

 

Coverage for the following Transplant Types is Offered:

Bone Marrow

Heart

Heart/Lung

Intestine

Kidney

Kidney/Pancreas

Liver

Lung

Pancreas

Stem Cell

 

Benefits to the Producer:

 

5% commission

 

Many stop loss carriers give a 2% to 10% credit on the specific stop loss for the transplant carve out, based on
stop loss specific deductible.

 

TPA Partners are waived of group minimum size, thus becoming a competitive differential for groups looking for
this coverage.

 

Extensive marketing assistance afforded to the producer from CGI to help sell the program.

 

A group can be eligible for this coverage regardless of their stop loss carrier, as long as they meet minimum
enrollment requirements.

 

High renewal persistency among groups with transplant carve out.

 

Carrier management of transplant exposures allows administrator to redirect internal clinical resources to more
chronic problems.

 

Which Groups Should Seriously Consider Adding This Coverage?

 

Unions and Associations often cap transplants at $250K and less, rendering it a less valuable benefit.

 

Large, completely self funded groups. Many don't want to sustain a single catastrophic hit such as Transplants and
may have a high frequency issue.

 

Groups that have experienced a transplant exposure in the past or groups where a laser has played havoc with their
stop loss insurance.

 

Groups that "have never had a transplant exposure".  The best time to buy transplant insurance is when the group is
completely clean of exposures.

 

  
Corporate Offices
Commercial Group Intermediaries
16 Executive Court
Suite 4
South Barrington, IL  60010

Main Number:  (847) 713-4700
Fax:  (847) 713-4701

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