Aggregate Excess Stop Loss Coverage

Aggregate Excess Insurance is designed to protect the employer who is concerned about the risk of unexpected benefit plan payments on the group as a whole.

Specific Excess Stop Loss Coverage

Specific Excess Insurance is designed to protect the employer against the severe impact of a catastrophic illness or accident incurred by an individual within the group.

 

Aggregate Excess Stop Loss Coverage
Single Employer Plans can be experience rated if they are 100 lives or more. Manually driven Aggregate coverage is also available for groups without prior claims experience.
The annual attachment point, the point at which the Insurance Company picks up the coverage, is normally based on 125% of the expected eligible paid claims. The minimum annual attachment point available is normally 120% of expected paid claims. If the annual attachment point is exceeded, 100% reimbursement of all eligible claims will be made following receipt of proof of loss at the end of the contract period. A Monthly Attachment, commonly referred to as Monthly Accommodation, is also available from most carriers.
Maximum coverage is normally $1,000,000, but requests for higher coverage limits will be considered by most carriers.
Aggregate coverage is normally written in conjunction with Specific Coverage.
Incurred and paid (12/12) contracts are available to fully insured groups in their first year of a self funded plan. Some groups continue with 12/12 contracts into future years as well.
Run-in (15/12 and/or 24/12) contracts are available in subsequent renewal years for groups who choose to protect themselves from Incurred But Not Reported (IBNR) claims.
Run-out (12/15) contracts allow for a 3 month extension for the insured to pay claims which were incurred prior to the end of the contract period.
Aggregate claim advances are available from some contract carriers.
The Terminal Liability Option is available for groups who wish to cover their IBNR claims, but do not want to go to the expense of a 12/15 contract.
Aggregate Only coverage is available from some carriers, subject to certain requirements.

 

 

Specific Excess Stop Loss Coverage
We can provide Single Employer Plans with retention amounts (Specific Deductibles) from as low as $10,000 to as high as $500,000, depending on the size of the group.
Coverage can be obtained for groups as small as 26.
Normal Specific Coverage is $1,000,000 less the Specific Deductible. Additional layers of coverage may be purchased, from $500,000 to $2,000,000.
Incurred and paid (12/12) contracts are available to fully insured groups in their first year of a self funded plan. Some groups continue with 12/12 contracts into future years as well.
Run-in (15/12 and/or 24/12) contracts are available in renewal years for groups who choose to protect themselves from Incurred But Not Reported (IBNR) claims.
Run-out (12/15) contracts allow for a 3 month extension for the insured to pay claims which were incurred prior to the end of the contract period.
Specific claim advances are available from most carriers after the group has paid the deductible.
Aggregating Specific contracts are available when the regular annual specific premium is in excess of $100,000.