Specific Stop Loss Coverage
..is designed to limit the employer's cost under a self funded health insurance plan for eligible medical expenses for each covered individual (as opposed to an aggregate of all covered individuals).
- Specific stop loss may be purchased without the purchase of aggregate stop loss.
- The per person deductible is determined before the start of the contract period, subject to certain minimum and maximum limits
- If eligible medical expenses on a covered individual exceed the policies deductible, the employer is reimbursed as specified in the contract.
- Specific claims are paid as soon as the deductible is met; the employer does not need to wait until the end of the contract period to submit a specific claim.
- The premium charge for this coverage is determined by a specific rate per covered employee per month, and a specific rate per covered dependent per month.
- A new deductible amount and new rates are established at each contract renewal. Contracts can run for more than a single calendar year.
- Specific Stop Loss contracts are generally offered on an incurred and paid basis.
- Only eligible medical expenses that were both incurred and paid while under contract are covered.