Definition

Insurance that caps the employer's claims exposure on a self-funded plan. Specific stop-loss caps per-claim cost; aggregate stop-loss caps total annual claims. Stop-loss carriers require detailed claims experience to underwrite.

Related in funding & risk

Fully insured

A funding arrangement where the employer pays a fixed monthly premium to a carrier, and the carrier bears all claims risk.

Self-funded

A funding arrangement where the employer pays claims directly out of cash flow (often through a TPA), bears the claims risk, and typically buys stop-loss insurance to cap downside.

Level-funded

A self-funded variant marketed mostly to small/midsize employers.

MLR

The ratio of premium dollars spent on member medical care vs.

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