What Is Aggregate Stop Loss Insurance

April 25, 2021

Unlike specific coverage, which responds on a per person basis, the aggregate protection responds to an accumulation of individual losses. The aggregate stop therefore introduces an element of ‘budgetary certainty’.

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Zurek conducts aggregate excess claim reviews and serves as a consultant for medical excess stop loss claim issues within the industry and provides litigation and managed care support.

What is aggregate stop loss insurance. Aggregate stop loss protection caps the annual aggregate loss. This is protection against abnormal frequency of claims in total rather than abnormal severity of a single claim (specific stop loss). Both are equally common among groups

It means if aggregate claims for the contract period exceed the aggregate deductible at the end of any month, there will be conditional reimbursement of the aggregate excess insurance benefit before the end of the contract period. Aggregate stop loss provides employers with a ceiling on the dollar amount of any eligible expenses that the employer would ordinarily pay during a contract period, thus providing protection for the entire group’s population. The stop loss underwriter and the employer agree on an aggregate amount, and if the amount spend on claims is more than that amount, the stop loss provider reimburses the employer.

Reimbursement amounts available are $1,000,000 and $2,000,000; Corridors of 20% and 25% The policy will reimburse the employers for eligible claims in excess of a predetermined amount at the end of the contract period.

Aggregate stop loss insurance offers a policy that protects employers from catastrophic loss. • reimbursement is made if total claims paid exceed the aggregate attachment point. The carrier reimburses the employer after the end of the contract period for aggregate claims.

Aggregate stop loss insurance works best if your organization is more concerned with overall costs, rather than costs associated with a specific individual employee. What aggregate stop loss does. In essence, this is a way for an insurance company to protect itself against too many.

For example, if an employer provides insurance for its employees but the costs for the company exceed 115% of projected costs, an aggregate stop loss insurance policy would pay for all the company's costs over this amount. Reinsurance purchased for excess of an aggregate loss limit. Aggregate stop loss insurance a company insurance policy that provides coverage on all expenses when another insurance policy exceeds its projected costs.

When a covered employee's medical claims exceed a predetermined limit, unum reimburses the. Normally, reimbursement for an aggregate stop loss claim is made at the end of the policy period This is an optional aggregate stop loss benefit.

Zurek is proficient in establishing claim reserves and serves as an industry expert in this area for several clients. Having an aggregate stop loss policy helps the employer budget for its healthcare costs with some accuracy, since this policy lets the employer put a dollar figure on its maximum potential liability for the plan year. Pricing of aggregate stop loss is determined by projecting a claim target and attaching a risk corridor.

The form of stop loss coverage that provides protection for the employer against the accumulation of total claims for the group as a whole exceeding a stated level. After that, claims for that period of insurance, become the responsibility of the insurer on a ‘ground up’ (or with a modest excess) basis. Aggregate stop loss protects against the overall utilization risk up to the specific deductible under the health plan.

An aggregate stop kicks in when claims within the excess reach an agreed total.

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