What is a stop loss underwriter?

Medical stop loss insurance, which is also referred to as excess insurance, is a service that protects employers from unpredictable, abnormally high claims and helps minimize losses. There are caps placed on the amount of liability a stop loss underwriter will assume, known as deductibles.

What is a stop loss threshold?

The threshold is calculated based on a certain percentage of projected costs (called attachment points)—usually 125% of anticipated claims for the year. An aggregate stop-loss threshold is usually variable and not fixed. This is because the threshold fluctuates as a percentage of an employer’s enrolled employees.

What is a stop loss provision in health insurance?

Stop loss insurance is a type of insurance policy carried by a self-funded health plan that protects against catastrophic medical expenses. This predetermined amount marks the point at which the medical claims would be considered excessive and potentially catastrophic.

What is a stop loss attachment point?

Put simply, a stop loss policy is a type of insurance coverage where the policy only pays after medical claims exceed a pre-determined amount. This stop loss policy’s attachment point (i.e. the predetermined amount above which the policy will pay claims) is $100,000 for all the claims in the health plan.

How does a stop loss policy work?

Under a stop-loss policy, the insurance company becomes liable for losses that exceed certain limits called deductibles. Aggregate Stop-Loss provides a ceiling on the dollar amount of eligible expenses that an employer would pay, in total, during a contract period.

What is out of pocket stop loss?

The dollar amount of claims filed for eligible expenses at which point you’ve paid 100 percent of your out-of-pocket and the insurance begins to pay at 100 percent. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.

What is a stop loss vs stop limit?

Stop-loss and stop-limit orders can provide different types of protection for both long and short investors. Stop-loss orders guarantee execution, while stop-limit orders guarantee the price.

What is the difference between fully insured and self-insured?

Fully-insured health plans are what most people are familiar with—a traditional group health plan from an insurance carrier. Self-insured plans are funded and managed by an employer, often in an effort to reduce premium costs.

What is the objective of a stop loss provision?

An insurance provision stating that the insurance company will pay all expenses after a set amount of out-of-pocket expenses have been paid.

What is a 15 12 stop loss contract?

15/12 – This covers claims paid within the policy year that are incurred during the policy year and the three months before the policy year begins. This type of contract is often referred to as a “run-in policy.”

What is the minimum attachment point?

Minimum Aggregate Deductible/Attachment Point The Minimum Aggregate Deductible or Minimum Attachment Point is the pre-determined level a stop-loss carrier will provide aggregate coverage for groups that have a reduction in enrollment.

What is the difference between out of pocket and Stop-Loss?

What is Stop Loss Coverage in insurance?

Stop-loss insurance is coverage for businesses that self-fund, or self-insure, their own employee health benefit plans. Rather than paying premiums to an insurance company to cover health care expenses for employees, self-insured employers pay their employees’ health claims and contract with companies to administer the health plan for each employee.

What is captive Stop Loss Coverage?

Captive insurance companies offer medical stop loss coverage as an alternative to fully insured insurance which is far more expensive but with less risk. While self funding insurance is more affordable, it does come with a higher level of risk.

What is stop loss deductible?

A stop-loss provision is a specific clause in a health insurance policy with a deductible and co-insurance arrangement that states that the insured need no longer pay any percentage of the medical expenses once their out-of-pocket expenses have reached the specific amount or limit indicated in the policy.

What is medical Stop Loss Coverage?

Medical Stop Loss. Medical stop loss coverage or more appropriately, excess of loss coverage, in intended to provide self funded employer health plans with financial protection in the event of catastrophic loss.