Overview
When a group's plan year ends, Yuzu reconciles all of that year's money and returns what's left over. This happens whether the group renews with Yuzu, moves to another carrier or terminates. A plan year is closed out once:
All medical, pharmacy and plan claims for the year have been paid, including claims that arrive after the year ends.
Total money in (claims funding, stop-loss reimbursements, Rx rebates), minus total money out (claims and pass-through vendor fees), equals the balance left in the claims fund, checked against actual cash.
Any leftover balance has been returned to whoever it belongs to.
The group doesn't need to start the close-out. Yuzu runs it and contacts the group if anything is needed.
Viewing Your Close-Out Summary
Each close-out comes with a Close-Out Summary. It shows the full reconciliation: all money in, all money out, and how the leftover balance was split. To open it:
Click into the group, then open the Stoploss tab.
Select the Stoploss Close Out entry, which is labeled with its close-out date.
Open the Attachments tab to download the Close-Out Summary.
Once a group is closed, a banner at the top of the page reads "This group is currently Closed" and shows the date the status changed.
Run-Out and Timing
A stop-loss contract has two windows:
the incurred window: when the care has to happen
the paid window: when the claim has to be paid
The extra time after the plan year ends is the run-out period. It lets late claims arrive and be paid.
Contract | Run-out period | Earliest return of leftover reserves |
|---|---|---|
12/12 | None | Shortly after the plan year ends |
12/18 | 6 months | About 6+ months after the plan year ends |
12/24 | 12 months | About 12+ months after the plan year ends |
During run-out:
Yuzu stops billing claims funding and fixed fees when the plan year ends. Run-out claims are paid from reserves already in the claims fund.
Level-funded groups get no more funding requests after month 12. For flex-funded groups, any funding not collected during the year is settled at close-out.
Reserves are returned once run-out ends and the reconciliation is done. They are not released automatically on a set date.
Reserves can't be returned sooner because the final surplus isn't known until every covered claim has been paid and the last carrier and rebate settlements have arrived. A claim for care in December can arrive in April. Waiting until the end means the group gets one final number and never has to pay anything back.
Where Leftover Money Goes
The claims fund holds two kinds of money:
The group's money: monthly claims funding, capped at the group's aggregate attachment point.
The carrier's money: stop-loss reimbursements for claims above the attachment point.
At close-out Yuzu works out whose money is left in the fund:
Leftover claims funding from the group always goes back to the group. This is the most common outcome, and it can happen even in a high-claims year, because the group never pays claims beyond its attachment point.
If the carrier paid in more than it ended up owing (for example, because rebates came in later), that excess goes back to the carrier.
Yuzu never keeps any part of the leftover balance.
Groups Renewing with Yuzu
The old plan year is still closed out on its own:
Claims are paid based on when the care happened. A claim for care during the old plan year is paid from the old year's fund, even if it arrives after the new year has started.
Each plan year balances on its own. If the old year's fund runs short paying late claims, money can be moved over from the new year to cover them. Each year must still balance to zero at its own close-out.
Which stop-loss policy covers a late claim depends on the contracts. On a 12/18 or 12/24, the old policy covers it during run-out. If a 12/12 renews into an 18/12 or 24/12, the new policy covers it, because its incurred window reaches back before the new plan year started.
The Final Month
The final month's invoice is generated on the 1st of the month and paid on the 5th. The usual dates are the 25th and the 1st.
Eligibility is locked once the final invoice is generated. Members added late, such as newborns, are billed on a separate one-off invoice.
Other Useful Information
Reserves are held in an account in the group's name.
A high-claims year does not use up the group's reserves beyond its attachment point. The stop-loss carrier covers everything above it.