Name the two main stop-loss protections used with self-funded plans and explain each.

Name the two main stop-loss protections used with self-funded plans and explain each.

• A. Catastrophic stop-loss and high-deductible synergy
• B. Per-claim stop-loss and per-employee stop-loss
• C. Specific stop-loss (per-claim) and aggregate stop-loss (per-employee/overall)
• D. Network stop-loss and product stop-loss

Answer: (C)

In self-funded plans, stop-loss protections are what cap the employer’s risk by shielding against high costs either for an individual or for the whole group. The two main protections are specific stop-loss and aggregate stop-loss. Specific stop-loss (per-claim) protects you from an astronomically high cost for a single member—the attachment point is set for each individual, and once a member’s claims exceed that threshold, the stop-loss coverage pays the excess up to the policy limit. This prevents one person’s costly care from overwhelming the plan’s budget. Aggregate stop-loss (per-employee/overall) guards against a year with unusually high total claims across all enrollees—the aggregate attachment point is for the entire group, and if total annual claims exceed that point, the insurer covers the excess for the group. Together, these two cover both extreme costs for individual members and spikes in overall claim experience. The other terms listed aren’t the standard pair used in this context.

In self-funded plans, stop-loss protections are what cap the employer’s risk by shielding against high costs either for an individual or for the whole group. The two main protections are specific stop-loss and aggregate stop-loss. Specific stop-loss (per-claim) protects you from an astronomically high cost for a single member—the attachment point is set for each individual, and once a member’s claims exceed that threshold, the stop-loss coverage pays the excess up to the policy limit. This prevents one person’s costly care from overwhelming the plan’s budget. Aggregate stop-loss (per-employee/overall) guards against a year with unusually high total claims across all enrollees—the aggregate attachment point is for the entire group, and if total annual claims exceed that point, the insurer covers the excess for the group. Together, these two cover both extreme costs for individual members and spikes in overall claim experience. The other terms listed aren’t the standard pair used in this context.