The Right Way to Buy Stop-Loss in 2026 | with Monique Burke

Monique Burke buys more stop-loss than almost anyone in this business, and the rate is the last thing she looks at.

She built OneDigital's stop-loss center of excellence starting with a spreadsheet, an offshore data team, and one other person. It's doubled year over year since. Now it covers everything from marketing a case through claims reimbursement, plus TPA and captive selection, because every time they solved one problem another piece of the stack turned out to be broken.

We get into what she checks first on every quote and why, the non-negotiables she won't place a policy without, and why a panel needs roughly ten carriers to function. Monique also explains why a carrier quoting 10% of what you send them is normal, what happens when an employer keeps a sick employee on the plan out of loyalty and finds out too late they weren't eligible, and what her underwriter and nurse are seeing right now in the claims data.

If you've ever put a stop-loss spreadsheet in front of a client, this one will change how you read it. Tune in.

“We look at what are the contingencies, what are the exclusions. Those are the two things I will always go to first, because that's going to make or break the policy or the decision. I don't care what your rate is." - Monique Burke, OneDigital

Thank you to our 2026 sponsors!

ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.

Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.

Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.

Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.

Chapters:

(00:00:00) Intro: Building a Stop-Loss Center of Excellence

(00:05:00) Why the TPA Choice Makes or Breaks the Plan

(00:10:25) If You Want Change, You Have to Make Changes

(00:16:00) Meet Monique Burke

(00:20:00) Tell Me the Problem, Not the Solution

(00:24:00) Building the Panel From Scratch

(00:26:00) Why You Need Ten Carriers

(00:28:00) They Quoted 48 Out of 412

(00:34:00) Pharmacy and the Claims Nobody Caught

(00:38:30) What the Claims Data Looks Like Right Now

(00:43:00) The Two Things She Checks First

(00:46:30) The Non-Negotiables

(00:48:30) The Eligibility Trap

(00:55:00) Inside OneDigital

(01:05:00) When a Captive Beats Going It Alone

(01:13:00) Closing Thoughts

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

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Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286

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