Stop Loss

Stop-Loss Insurance Manage risk

minimize liability

Clients with self-funded healthcare plans can manage unexpected medical claim risks with stop-loss coverage. Humana offers both specific stop-loss and aggregate stop-loss, along with aggregating specific as an optional benefit.

Why Stop-Loss?

Stop-Loss insurance lets your clients select the amount of risk based on their comfort level. High-dollar claims and high use can have an overall negative effect on a health plan.

    Clients can:
    • Choose the amount of risk they're comfortable with
    • Protect cash flow
    • Defend against rising healthcare costs

Specific Stop-Loss insurance

Specific stop-loss coverage protects clients from large medical claims from any one person. It provides coverage when a claim exceeds a certain threshold or deductible, and meets certain guidelines.

    Clients can:
    • Tailor plans to specific needs
    • Choose from a range of contract types
    • Enjoy deductible rewards programs

Aggregating specific Stop-Loss option

With an aggregating specific option, clients agree to accept an amount of additional risk in exchange for paying lower premiums. It’s an option recommended to clients financially suited to accept additional risk. Once the aggregating specific amount is reached, Humana makes reimbursements.

    • Good for larger cases where the incidence of large claims becomes more predictable
    • Also effective for smaller cases with known, ongoing claim situations

Aggregate Stop-Loss insurance

Aggregate Stop Loss provides protection for clients from claims that were higher than anticipated across the entire group. An annual attachment point is determined based on claims experience, plan design, and a choice of corridor percentages. When the total claims exceed the annual attachment point, the client is reimbursed for the amount over the limit.

    • Sold with specific stop-loss coverage
    • Clients can choose from a range of contract types
    • Standard risk corridor is 25% of expected claims
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