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Specific Stop Loss
Specific Stop Loss reimburses the employer for a catastrophic claim on any covered individual during a contract period. The employer must first satisfy the “per person” deductible before reimbursement of Aggregate claims begins.
Typical Stop Loss Contract Periods
- 24/12: Employer plan claims are covered by the Stop Loss policy only if they are incurred within 12 months prior to the effective date of the policy and paid during the policy term.
- 12/12: Employer plan claims are covered by the Stop Loss policy only if they are incurred and paid during the policy term; this is a common first-year-only transition contract for larger, fully insured employers and commonly renews into a 24/12 contract to avoid a gap in coverage.
- 12/15: Employer plan claims are covered by the Stop Loss policy only if they are incurred during the policy term and paid within 90 days of the end of the policy term.
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