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There are two types of stop-loss insurance coverage: specific stop-loss and aggregate 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.

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.

Stop-loss insurance (also known as excess insurance) is a product that provides protection for self-insured employers by serving as a reimbursement mechanism for catastrophic claims exceeding pre-determined levels.

That's where stop-loss insurance comes in. This type of insurance protects you from paying excess healthcare costs under your self-funded plan so you can continue providing your employees full coverage for their eligible expenses.

At what point does a self-insured group qualify for stop-loss coverage? after claims exceed a specified limit in a set period of time.

Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees' and dependents' medical claims.

The stop-loss feature places a limit on the maximum out-of-pocket expenses an insured must incur for health care, above which the policy pays 100% of the remaining eligible expenses.

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We offer stop loss insurance with comprehensive coverage that aligns with the employer's plan document. How does your current stop loss policy compare?Stop Loss Checklist for ASO-Administered Groups. Segal works with hundreds of group medical plans to help them get the medical stoploss insurance that best meets their needs. This Checklist Applies to the Following Types of Insurance (TOI):. If the total claims go above the aggregate limit, the insurer would reimburse the company. Missouri Statues and Regulations always prevails over this checklist. Page 1 completed along with a member level census. Health Form Filing Checklists ; Pediatric Dental Essential Health Benefit Checklist - 467K ; Provider Directory Checklist - 332K ; Date of Filing Checklist - 411K. Typically, you will want to include personal, financial, and health information.

Texas Group Health Stop Loss Checklist

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