stop loss insurance

Stop loss insurance is insurance coverage that is purchased by a health plan or self-funded employer to provide protection from losses resulting from claims over a specific dollar amount per member per year (calendar year or illness to illness).

Types of stop-loss insurance:

Specific or individual

Reimbursement is given for claims on any covered individual which exceed a predetermined deductible, such as $50,000 or $100,000.

Aggregate

Reimbursement is given for claims which in total exceed a predetermined level, such as 125% of the amount expected in an average year.

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