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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. Most large companies are self-insured.

Key takeaways

  • Stop-loss insurance is a form of coverage for self-insured businesses that pay their employees' health claims. 
  • Specific stop-loss coverage protects against extreme losses for those covered by the plan. 
  • Aggregate stop-loss coverage protects employers when total claims by the entire group surpass a certain level.
  • Stop-loss insurance indirectly benefits consumers by allowing employers to assume risks securely and provide health benefits to their employees and dependents.

What are the types of stop-loss insurance? 

By self-funding their own plans, businesses take on the risk of their employees' healthcare expenses. Stop-loss insurance is a layer of protection in case health insurance claims exceed a certain threshold.

There are two types of stop-loss insurance--specific and aggregate coverage. Specific stop-loss insurance covers extreme losses for a person covered by the plan. Say, for instance, an employee has a catastrophic illness or injury and racks up extraordinary medical bills. The specific stop-loss coverage would kick in when the bills exceeded a certain level defined in the policy.

Aggregate stop-loss coverage protects employers when total claims by the entire group exceed a certain level, such as 125 percent of the cost of projected claims.

Although you never deal directly with stop-loss insurance as a consumer, the coverage provides an indirect benefit by enabling employers to take on risk safely and provide health benefits to their employees and dependents.

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