- What is a specific deductible?
- What is an attachment point in stop loss?
- What is an aggregate deductible?
- What is first dollar coverage?
- What is a laser in stop loss?
- What is a 12 15 stop loss contract?
- What are stop loss claims?
- What is a corridor deductible?
- What is out of pocket stop loss?
- What is leveraged trend?
- What is a stop loss Corridor?
- How does aggregate stop loss work?
- What are attachment and detachment points?
- How does an aggregating specific deductible work?
- What is aggregate limit?
- What is attachment point?
- What is the difference between stop loss and reinsurance?
- How does a self funded health plan work?
What is a specific deductible?
Specific Deductible: The dollar amount to be paid by the plan on each covered individual before the stop loss policy kicks in to reimburse expenses incurred during the contract period..
What is an attachment point in stop loss?
Attachment Point Specified limit when a stop-loss insurance contract will pay for an individual or claim. The dollar amount above which specific stop-loss protection begins to pay is called the specific attachment point.
What is an aggregate deductible?
Aggregate deductibles are often used in family health insurance policies and under them. 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 first dollar coverage?
First dollar coverage is a type of insurance policy with no deductible where the insurer assumes payment once an insurable event occurs. While there is no deductible, the amount the insurer will pay out is often lower than on similar plans that have a deductible, or premiums for the first dollar plan will be higher.
What is a laser in stop loss?
What does “laser” mean in stop loss insurance? A laser is the practice of assigning a higher Specific deductible for an individual with a known condition that is likely to exceed the Specific deductible.
What is a 12 15 stop loss contract?
12/15 – This covers claims incurred within the policy year and paid within three months after the policy year ends. This type of contract is often referred to as a “run-out policy.”
What are stop loss claims?
Stop-loss insurance (also known as excess insurance) is a product that provides protection against catastrophic or unpredictable losses. … Specific Stop-Loss is the form of excess risk coverage that provides protection for the employer against a high claim on any one individual.
What is a corridor deductible?
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 is out of pocket stop loss?
The dollar amount of claims filed for eligible expenses at which point you’ve paid 100 percent of your out-of-pocket and the insurance begins to pay at 100 percent. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.
What is leveraged trend?
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.
What is a stop loss Corridor?
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.
How does aggregate stop loss work?
Aggregate stop-loss insurance is a policy designed to limit claim coverage (losses) to a specific amount. … Aggregate stop-loss protects the employer against claims that are higher than expected. If total claims exceed the aggregate limit, the stop-loss insurer covers the claims or reimburses the employer.
What are attachment and detachment points?
The attachment point indicates the minimum of pool-level losses at which a given tranche begins to suffer losses. In turn, the detachment point corresponds to the amount of pool losses that completely wipe out the tranche.
How does an aggregating specific deductible work?
The aggregating specific deductible goes by many names. … When an aggregating specific deductible is employed, the client assumes additional liability in exchange for a lower premium. The ASD is a set dollar amount that is used to cover a single claimant or many claimants, who exceed the specific deductible.
What is aggregate 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. … Health insurance plans often carry aggregate limits.
What is attachment point?
Attachment Point — the point at which excess insurance or reinsurance limits apply. For example, a captive’s retention may be $250,000; this is the “attachment point” at which excess reinsurance limits would apply.
What is the difference between stop loss and reinsurance?
In order to avoid these issues, healthcare payers often pass on excess risk that they cannot tolerate to secondary payers. 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.
How does a self funded health plan work?
Self-insurance is also called a self-funded plan. This is a type of plan in which an employer takes on most or all of the cost of benefit claims. The insurance company manages the payments, but the employer is the one who pays the claims.