Texas Group Health Stop Loss Checklist
Description
How to fill out Texas Group Health Stop Loss Checklist?
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FAQ
The stop-loss feature places a limit on the maximum out-of-pocket expenses an insured must incur for health care, above which the policy pays 100% of the remaining eligible expenses.
Type of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees' and dependents' medical claims.
At what point does a self-insured group qualify for stop-loss coverage? after claims exceed a specified limit in a set period of time.
That's where stop-loss insurance comes in. This type of insurance protects you from paying excess healthcare costs under your self-funded plan so you can continue providing your employees full coverage for their eligible expenses.
Stop-loss insurance (also known as excess insurance) is a product that provides protection for self-insured employers by serving as a reimbursement mechanism for catastrophic claims exceeding pre-determined levels.
The threshold is calculated based on a certain percentage of projected costs (called attachment points)?usually 125% of anticipated claims for the year. An aggregate stop-loss threshold is usually variable and not fixed. This is because the threshold fluctuates as a percentage of an employer's enrolled employees.
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.
There are two types of stop-loss insurance coverage: specific stop-loss and aggregate stop-loss.