Determine optimal stop-loss coverage for self-funded health plans. Analyze specific and aggregate deductible options to balance premium costs with risk protection.
Stop-loss insurance protects self-funded employers from catastrophic claims that could exceed their financial capacity. It's essential risk management for any organization paying claims directly rather than through fully-insured premiums.
Individual claim protection
Protects against high-cost individual claimants. When a single person's claims exceed the specific deductible, stop-loss reimburses the excess.
Total claims protection
Caps total annual claim liability. When combined claims exceed the aggregate attachment point, stop-loss pays the excess.
| Deductible Level | Premium Impact | Employer Risk | Best For |
|---|---|---|---|
| $25,000 | Highest | Lowest | Very risk-averse, small groups |
| $50,000 | High | Low | Small groups (25-75 employees) |
| $75,000 | Moderate-High | Low-Moderate | Mid-size groups (50-150) |
| $100,000 | Moderate | Moderate | Common choice for 100+ groups |
| $150,000 | Low-Moderate | Moderate-High | Larger, healthy groups |
| $200,000+ | Lowest | Highest | Large groups with reserves |
| Corridor % | Employer Risk | Premium Impact | Notes |
|---|---|---|---|
| 120% | Lowest | Highest | Maximum protection, minimum risk |
| 125% | Low | Moderate | Most common corridor level |
| 130% | Moderate | Low | Balance of cost and protection |
| 135% | Higher | Lowest | Higher risk tolerance required |
Carriers may "laser" (increase deductible for) specific high-risk individuals. Review laser provisions carefully and negotiate alternatives.
Some carriers offer protection against new lasers at renewal. This provides cost predictability for known conditions.
Coverage for claims incurred during the policy year but paid after termination. Critical for plan transitions.
How the aggregate attachment is spread monthly. 1/12 accommodation provides more protection early in the year.
Planlined helps you compare self-funded, level-funded, and fully-insured options with accurate cost projections.
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Plain-English definitions of the terms brokers meet in quotes, renewals and compliance: level-funded, stop-loss, MLR rebate, ACA affordability, SBC, composite rates, ICHRA and more, each linked to the Planlined guide or calculator that goes deeper.