1. 5527 POINTS
    Marlin McKelvy
    President, Consumer Directed Benefit Solutions, Memphis, Tennessee
    Some people use the term "stop loss" to mean "maximum out-of-pocket exposures" which is the point in a person's health insurance policy when they've met their deductible and any co-insurance cost sharing and the health insurance carrier becomes 100% responsible for all health care costs after that point. 

    Technically this is an incorrect use of the term.  Stop loss traditionally refers to reinsurance arrangements within self-insured group health insurance plans.  There are two types of stop loss insurance, specific and aggregate.  Specific stop loss insurance protects the group plan from claims exposure above a certain point for any insured person in the group.  For example, a $50,000 specific stop loss policy means the employer accepts the risk for the first $50,000 in claims on an individual and after that point the reinsurance carrier pays the rest of the cost.  Aggregate stop loss insurance protects the employer from claims liability for the entire insured group above a certain point.  A $1 million aggregate stop loss policy means the employer accepts the liability for the first $1 million in claims for their entire insured group, if the group's claims exceed this limit then the aggregate reinsurance carrier pays the rest of the cost.
    Answered on July 31, 2014
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