Catastrophic Stop-Loss Insurance Broker in San Antonio, TX
One catastrophic claim at a San Antonio medical center can exceed a year of premiums for a self-funded employer without stop-loss coverage. Wilkerson Insurance Agency structures and places that protection at no broker fee.
Request a Free Stop-Loss Consultation — San Antonio
No broker fee. We model specific deductibles, aggregate attachment points, contract types, and laser terms for your group.
What Catastrophic Stop-Loss Insurance Covers for San Antonio Employers
Stop-loss insurance, also called excess loss coverage, is purchased by employers who self-fund their employee health benefit plan. When an employer self-funds, it pays medical claims directly rather than paying fixed premiums to a carrier. The potential savings can be meaningful, but the liability without stop-loss protection is open-ended. A single cancer treatment, organ transplant, or cell and gene therapy claim can generate a bill that rivals an employer’s annual operating budget.
Stop-loss is not limited to large corporations. Most employers with 200 or more employees use some form of self-funded structure, and a growing number of San Antonio businesses with 25 to 200 employees are moving into level-funded and self-funded models. Without stop-loss, claims management and wellness programming cannot eliminate the tail risk of one catastrophic event.
For a statewide overview of how this coverage fits into employer health-plan structures, visit our Texas catastrophic stop-loss plans page.
Stop-loss is not optional for most self-funded employers. It is the structural foundation that makes self-funding viable in the first place.
Two Types of Stop-Loss Coverage Every San Antonio Employer Should Understand
Protects the employer against catastrophic claims from a single covered individual.
A $100,000 specific deductible means the employer pays the first $100,000 of one person’s eligible claims in the plan year. The stop-loss carrier reimburses eligible amounts above that threshold.
Individual Claim ProtectionProtects against a plan year in which total claims across the group rise far above projections, even when no single person reaches the specific deductible.
The aggregate attachment point is commonly set at 110% to 125% of expected annual claims.
Total Plan-Year Protection| Feature | Specific Stop-Loss | Aggregate Stop-Loss |
|---|---|---|
| Trigger | One covered person’s claims exceed the specific deductible. | Total group claims exceed the aggregate attachment point. |
| Attachment point | Set per individual, commonly $75,000 to $250,000. | Set as a percentage of expected claims, commonly 110% to 125%. |
| Primary risk | One catastrophic claimant, such as cancer, transplant, or NICU care. | A high-frequency bad claims year across many employees. |
| Reimbursement | Eligible claims above the specific deductible for each individual. | Total eligible claims above the aggregate threshold for the plan year. |
| Who needs it | Every self-funded employer, regardless of group size. | Most self-funded employers with fewer than 500 covered lives. |
How Attachment Points Are Calibrated for San Antonio Groups
The specific deductible and aggregate attachment point are not sold off the shelf. They are modeled from the employer’s covered lives, prior claims experience, industry, employee demographics, cash reserves, and financial risk tolerance.
| Group Size | Typical Specific Deductible | Typical Aggregate Attachment |
|---|---|---|
| 25 to 100 covered lives | $50,000 to $100,000 | 115% to 125% of expected claims |
| 100 to 250 covered lives | $75,000 to $150,000 | 115% to 120% of expected claims |
| 250 to 500 covered lives | $100,000 to $250,000 | 110% to 120% of expected claims |
| 500 and above | $200,000 to $500,000 or higher | 110% to 115% of expected claims |
A lower specific deductible causes more claims to qualify for reimbursement but increases the stop-loss premium. A higher deductible lowers the premium but leaves more risk with the employer. We model multiple deductible levels against the group’s claims history before recommending a structure.
San Antonio employers with healthcare-sector workforces or older average employee ages may need lower specific deductibles than peer groups of the same size. We adjust recommendations for industry and demographics, not headcount alone.
Need your current attachment points stress-tested?
We model specific and aggregate scenarios against your claims history and financial tolerance at no broker fee.
Laser Exclusions: What Every San Antonio Employer Must Understand Before Renewing
A laser is a stop-loss provision that assigns different terms to a named individual or known high-cost diagnosis. A laser may raise that person’s specific deductible, exclude a diagnosis, or remove the person from specific stop-loss protection altogether. The employer then retains substantially more, or all, of the financial exposure for that claimant.
Lasers commonly appear at renewal after a high-cost claim. If an employee receives a $500,000 cancer treatment at CHRISTUS Santa Rosa during the contract year, the carrier may propose a laser on that individual or diagnosis category for the next year. The employer could then carry the full exposure for ongoing treatment.
Three Contract Terms That Most Often Create Claim-Time Surprises
- Laser clauses: named high-cost claimants or diagnoses receive a higher deductible or reduced coverage.
- Run-out and run-in provisions: claim timing determines whether late-paid or transition-period claims are reimbursable.
- Aggregate corridor structure: small wording and factor changes can materially increase the employer’s retained plan-year exposure.
We review every laser provision in every contract, negotiate its scope and duration at renewal, and identify known high-cost claimants before contract execution. A contract with broad laser terms is materially different from one without them, regardless of the premium shown on the comparison sheet.
Modern Claim Categories Driving Stop-Loss Exposure for San Antonio Employers
GLP-1 Weight-Management Medications
Ozempic, Wegovy, Mounjaro, and related medications can cost $1,000 to $1,400 per member per month at list price. Twenty covered users can create $240,000 to $336,000 in annual exposure before other claims are counted.
Cell and Gene Therapy
CAR-T and other advanced therapies can carry list prices from $400,000 to more than $3 million per treatment. The specific deductible is the financial barrier between that claim and the employer’s operating account.
Premature Birth and NICU Care
Extended NICU stays at University Hospital or CHRISTUS Children’s Hospital can exceed $300,000 in complex cases. These claims are especially relevant for workforces with many employees in their reproductive years.
Organ Transplants and Major Surgery
Kidney, liver, heart, and lung transplants at major San Antonio systems can generate claims from approximately $250,000 to $800,000 or more, depending on organ type and complications.
Stop-Loss Contract Types: 12/12, 15/12, and 24/12
Stop-loss contracts define both when a claim must be incurred and when it must be paid. The contract type determines whether claims near the beginning or end of the plan year receive coverage, making this choice especially important when an employer changes carriers or enters self-funding for the first time.
| Contract Type | Incurred Window | Paid Window | Best For |
|---|---|---|---|
| 12/12 | 12 months | 12 months | Established plans renewing with the same carrier and minimal transition risk. |
| 15/12 | 15 months, including a 3-month run-in | 12 months | Employers switching carriers with known mid-treatment claimants. |
| 24/12 | 24 months, including a 12-month run-in | 12 months | Employers new to self-funding or transitioning with high-cost ongoing cases. |
A 12/12 contract can create a transition gap when claims are incurred late in the prior contract but paid after that contract ends. A 15/12 or 24/12 structure with run-in coverage can eliminate that gap. Most San Antonio employers switching stop-loss carriers or moving from fully insured coverage should evaluate at least a 15/12 option.
The lowest stop-loss premium is not automatically the lowest-cost contract. Deductible levels, lasers, run-in and run-out language, aggregate factors, and reimbursement terms determine the employer’s real exposure.
What Wilkerson Insurance Agency Does as a Stop-Loss Broker
Stop-loss is not a commodity product. The deductible, contract type, laser provisions, aggregate corridor, reimbursement language, and carrier financial strength interact in ways that a premium comparison alone cannot capture.
- Compare quotes from multiple Texas Department of Insurance-licensed stop-loss carriers, including carriers specializing in mid-market Texas employer groups.
- Model specific deductibles and aggregate attachment points against prior claims experience to identify an appropriate risk structure, not simply the lowest premium.
- Review laser exclusions, renewal terms, reimbursement provisions, and aggregate corridor language before contract execution.
- Advise on 12/12, 15/12, and 24/12 contract structures based on the employer’s transition status and known high-cost claimants.
- Reprice coverage against the market annually instead of accepting renewal terms without competitive review.
- Monitor aggregate levels during the plan year when an employer is approaching its attachment point.
Employers evaluating the broader funding structure can also review our Texas group health insurance plans and our guide to level-funded health plans for Texas small businesses.
San Antonio Employer Groups Commonly Using Stop-Loss Coverage
| Industry Segment | Why Stop-Loss Matters |
|---|---|
| Military contractors and federal service providers | Government contractors near Joint Base San Antonio often use self-funded structures for greater plan flexibility and cost control. |
| Healthcare employers | Clinics, hospitals, and allied-health employers often carry higher claims exposure; stop-loss is a standard component of self-funded healthcare groups. |
| Financial and professional services | Regional banks, law firms, consulting practices, and larger professional employers frequently self-fund to gain plan-design flexibility and capture savings. |
| Retail, hospitality, and distribution | These employers increasingly use level-funded plans with an embedded stop-loss component in the fixed monthly structure. |
| Technology and SaaS | Younger, higher-income workforces can create material GLP-1, specialty drug, behavioral health, and family-forming claim exposure. |
| School districts and municipalities | Texas public entities frequently self-fund and purchase stop-loss through TDI-licensed carriers outside the state employee program. |
Wilkerson Insurance Agency has served Texas employers across Dallas–Fort Worth, Houston, Austin, and San Antonio for more than 15 years. Our stop-loss clients include businesses with approximately 25 to 500 covered lives that need a broker who understands the complete contract, not only the lowest premium.
Request Your Free San Antonio Stop-Loss Review
Specific deductibles, aggregate attachment points, laser terms, contract types, and carrier options compared in one consultation.
Our licensed team helps San Antonio employers evaluate self-funded and level-funded risk, compare TDI-licensed stop-loss carriers, and understand the contract terms that determine reimbursement at claim time.
The right stop-loss structure caps your self-funded plan’s catastrophic exposure before a high-cost claim reaches your balance sheet. Our service costs you nothing extra. The analysis is real. And the right contract makes all the difference.