|
Term |
Description |
|
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. You may also have an Aggregating Specific, which applies a corridor of claims between the actual Specific Deductible and when the carrier begin to be responsible for claims. |
|
Self-Insured Plan |
Refers to an employee benefit plan where the employer alone is liable for all benefits provided for under the provisions of the plan. |
|
Self-Funded Plan |
Refers to an employee benefit plan where the employer will pay a certain portion of the benefits liability and an insurance company will pay the excess balance, if any. |