HOW IT WORKS
Specific Stop Loss (or Individual Stop Loss): The Stop Loss Carrier and the Owner will agree to a threshold where once an individual member’s claims exceed that amount, the Stop Loss Carrier will assume responsibility for claims paid for services incurred by that member during the remainder of the contract term. The threshold is also known as the stop loss deductible.
EXAMPLE
Owner XYZ has 150 employees enrolled. Their Specific Stop Loss Deductible is $70,000.
Member A has claims that totaled $100,000
- Owner XYZ would pay the first $70,000 of claims
- Stop Loss Carrier would pay the remaining $30,000
Member B has claims that totaled $150,000
- Owner XYZ would pay the first $70,000 of claims
- Stop Loss Carrier would pay the remaining $80,000
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