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Specific Stop-Loss coverage is designed to limit the employer's cost for eligible medical expenses for each covered individual. This coverage addresses the employer's exposure to high expenses on a given individual (as opposed to an accumulation of expenses on all covered individuals). Specific Stop-Loss may be purchased without the purchase of Aggregate Stop Loss.

The per person deductible is determined before the start of the contract period, subject to certain minimum and maximum limits. If eligible medical expenses on a covered individual exceed the policies deductible, the employer is reimbursed as specified in the contract. Specific claims are paid as soon as the deductible is met; the employer does not need to wait until the end of the contract period to submit a specific claim.

The premium charge for this coverage is determined by a specific rate per covered employee per month, and a specific rate per covered dependent per month.

A new deductible amount and new rates are established at each contract renewal. Contracts can run for more than a single calendar year.

Specific Stop-Loss contracts are generally offered on an incurred and paid basis. Only eligible medical expenses that were both incurred and paid while under contract are covered. [back] [next]