What is Aggregate Stop-Loss Insurance?

What is Aggregate Stop-Loss Insurance?

Aggregate stop-loss insurance is a policy designed to limit claim coverage (losses) to a specific amount. This coverage ensures that a catastrophic claim (specific stop-loss) or numerous claims (aggregate stop-loss) do not drain the financial reserves of a self-funded plan.

What is an aggregate deductible in stop-loss?

The Aggregate Specific Deductible covers the entire group and must be satisfied before an employer can get reimbursed. Three employees each have claims that exceed the $200,000 Specific Deductible.

What is an aggregate stop-loss attachment point?

Aggregate stop loss puts a cap on the amount that a self-insured employer has to pay across an entire plan year. … That number is multiplied by a percentage (commonly 125 percent) to determine the plan’s aggregate attachment point.

What does aggregate premium mean?

Aggregate Premium means the Premium required for all Members. Aggregate Premiums are shown on all Premium Statements. Application means the Employer enrollment form. … Employer Enrollment Form means the Group’s application for Coverage.

What is an aggregate deductible?

An aggregate deductible means that the entire family deductible must be paid out of pocket before the company pays for services for one family member.

What is an aggregate factor?

Aggregate Factors: The dollar figures that are used to calculate a plan’s maximum monthly and/or annual financial risk (i.e., the aggregate attachment point).

How does annual aggregate deductible work?

Annual Aggregate Deductible (1) A deductible-type program under which the insured agrees to reimburse its insurer for its own losses during the policy year up to the agreed upon annual aggregate amount.

How does Specific stop-loss Work?

Specific Stop-Loss is the form of excess risk coverage that provides protection for the employer against a high claim on any one individual. This is protection against abnormal severity of a single claim rather than abnormal frequency of claims in total. Specific stop-loss is also known as individual stop-loss.

What does aggregate corridor mean?

an Aggregate Attachment Point (corridor); this percentage is. used to determine the monthly Aggregate deductible amount. for the policy term, and the group is expected to be able to fund. the anticipated claims, plus the additional amount (corridor) Common Stop Loss Contract Periods.

What is the difference between stop-loss and reinsurance?

If the primary payer is itself an insurance plan, this protection is known as reinsurance, while if the primary payer is a self-insured employer, it is commonly known as stop-loss insurance.

What is the difference between stop-loss and excess of loss reinsurance?

That is the reason why, the stop loss reinsurance is also known as Aggregate Excess of Loss Reinsurance. For example, a 100% stop loss means that the reinsurer covers as soon as the total claims amount are at the same level or above the premiums amount. The higher the loss ratio, the worse the results.

What is a minimum annual aggregate deductible?

The Minimum Aggregate Deductible or Minimum Attachment Point is the pre-determined level a stop-loss carrier will provide aggregate coverage for groups that have a reduction in enrollment.

What does aggregate loss mean?

Aggregate Losses means the total amount of money you have actually Paid during the Benefit Period as indicated in the Schedule of Insurance, or on behalf of, all covered persons under your Employee Benefit Plan.

What does aggregate mean on an insurance policy?

For various types of insurance, an aggregate limit is the maximum amount of money an insurer will pay for all your covered losses during the policy period, typically one year.

What is an aggregate insurance policy?

Aggregate (1) A limit in an insurance policy stipulating the most it will pay for all covered losses sustained during a specified period of time, usually a year. Aggregate limits are commonly included in liability policies.

What does aggregate mean in healthcare?

[agr?-gat] individuals, families, or other groupings who are associated because of similar social, personal, health care, or other needs or interests.

Is aggregate or embedded deductible better?

If you have one person that incurs a significant amount of medical expenses, an embedded deductible will probably be best. On the other hand, if you have two or more people incurring a moderate amount of medical expenses, an aggregate approach would probably be more beneficial.

How is aggregate deductible calculated?

As each member of the family uses and pays for healthcare services, the amount they pay out-of-pocket for those services is credited toward the family’s aggregate deductible. After several family members have paid deductible expenses, the combined total of those expenses reaches the aggregate deductible.

What is an aggregate run in limit?

An aggregate limit is a maximum amount an insurer will reimburse a policyholder for all covered losses during a set time period, usually one year. Insurance policies typically set caps on both individual claims and the aggregate of claims.

What is leveraged trend in stop-loss?

Leveraged Trend is the effect of first-dollar medical inflation, which, as mentioned earlier, can average anywhere from 6% – 10% per year, on stop-loss claims. A simple illustration: assume an employer with a self-insured health plan has stop loss coverage with a $50,000 specific deductible.

How is aggregate corridor calculated?

What is the difference between aggregate and stacked deductible?

Stacked deductible – Plan pays for an individual once the individual deductible is met, even on a two-person or family plan. Aggregate deductible – Full single or entire family deductible must be satisfied before benefits are paid.

What does annual aggregate limit?

What Does Annual Aggregate Limit Mean? The annual aggregate limit is the maximum amount of coverage an insurance policy provides over a policy year. It is found in a wide variety of insurance types, such as auto, health, and property.

How do you calculate aggregate stop-loss?

An example of deriving the Aggregate Stop-Loss coverage is as follows:
  1. First, the employer and stop-loss carrier establish the average expected monthly claims, for this example $300 PEPM.
  2. This figure is then multiplied by a percentage usually ranging between 110%-150%, for this example 150%.

What is an aggregate accommodation?

Aggregate Accommodation is a supplement to the Aggregate Contract designed to protect the plan during months where claim activity may be inordinately high. It is intended to provide for a maximum monthly exposure when the plan is fully funded.

What is a specific deductible in health insurance?

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

What is an insurance loss Corridor?

A corridor deductible is expenses paid by the insured in excess of an insurance policy’s coverage limit, but below the threshold at which additional coverage options are available.

What are the two types of reinsurance?

There are two basic types of reinsurance arrangements: facultative reinsurance and treaty reinsurance.

What is stop loss reinsurance?

Definition. Stop-loss reinsurance is a type of excess of loss reinsurance wherein the reinsurer is liable for the insured’s losses incurred over a certain period (usually a year) that exceed a specified amount or percentage of some business measure, such as earned premiums written, up to the policy limit.

What is a stop-loss order in stocks?

A stop order, also referred to as a stop-loss order, is an order to buy or sell a stock once the price of the stock reaches a specified price, known as the stop price. When the stop price is reached, a stop order becomes a market order. A buy stop order is entered at a stop price above the current market price.

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