Definition of "Stop loss insurance"
Coverage purchased by employers in order to limit their exposure under self insurance medical plans. This coverage is available in two types:
- Specific stop loss Coverage is initiated when a claim reaches the threshold selected by the employer. After the threshold is reached, the stop-loss policy would pay claims up to the lifetime limit per employee for the self insurance medical plan.
- Aggregate stop loss Coverage is initiated when the employer's self insurance total group health claims reach a stipulated threshold selected by the employer. Typically, this threshold is 125% of the self insurer's annual estimated group health claims cost.
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