Aggregate Stop-Loss
Aggregate stop-loss insurance limits the overall annual claims liability by reimbursing the company when the claims paid for the self-funded plan, as a whole, exceed a certain preset level.
Attachment Point
For aggregate stop-loss insurance it is the point at which the stop-loss insurance carrier reimburses the employer based upon the cumulative total of claims paid within a contract period.
Contract Period
The time covered under a contract designating when a claim is incurred and when the claim must be paid to qualify for reimbursement.
Plan Year
The 12-month period in which deductible and co-insurance accumulates toward a plan participant's out of pocket maximums.
Reinsurance
Another term for stop-loss coverage.
Run-In
Claims incurred prior to a plan year but reported after the end date of the plan year. These claims can be paid under the "current year" contract that includes the run-in period and the current plan year claims.
Run-Out
Claims incurred during a plan year but reported after the end date of the plan year. These claims can be paid under the "prior year" contract.
Specific Stop-Loss
Individual or specific stop-loss insurance provides reimbursement in the event an individual plan participant has claims that exceed the specific deductible during a contract period.
Specific Deductible
The amount of claims for which the plan is responsible for on any one individual in a contract period.
