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Insurance companies themselves, as well as self-insuring employers, purchase stop-loss coverage for a premium to protect themselves. [1] In the case of a participant reaching more than the specific (or "individual") stop-loss deductible ($300,000, for example), the insurer will reimburse the insured (the company, not the participant) for the remainder of the claim to be paid over that ...
Firms are often "self-insured", meaning they reimburse the insurance companies that pay the medical claims on behalf of their employees. Employers may use a stop-loss, meaning they pay the insurance company a premium to cover very expensive individual claims (e.g., the firm is self-insured up to a threshold for individual workers).
A leading stop-loss insurance carrier announces SunElite, SM a medical plan document review service to help self-insured employers comply with the Affordable Care Act and manage cost containment
The negative aspects of the project included difficulties in billing and collection. [16] A 2001 paper examining three of the original four hospitals with comparable "micro-cost" data determined that "the cost reductions primarily came from nursing intensive care unit, routine nursing, pharmacy, and catheter lab." [17]
The stop-loss policy runs solely between the employer and the stop-loss carrier and creates no direct liability to those individuals covered under the plan. This feature provides the critical distinction between fully insured plans (subject to state law insurance regulations) and self-funded health plans, which, under the provisions of Section ...
Stop-loss may refer to: Stop-loss insurance, an insurance policy that goes into effect after a set amount is paid in claims; Stop-loss order, stock or commodity market order to close a position if/when losses reach a threshold; Stop-loss policy, US military requirement for soldiers to remain in service beyond their normal discharge date
This is an accepted version of this page This is the latest accepted revision, reviewed on 12 January 2025. Equitable transfer of the risk of a loss, from one entity to another in exchange for payment "Insure" redirects here. Not to be confused with Ensure. For other uses, see Insurance (disambiguation). An advertisement for a fire insurance company Norwich Union, showing the amount of assets ...
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related to: stop loss in medical billing