What is the typical specific stop-loss deductible?

Specific deductibles typically range from $25,000 to $250,000+ depending on group size and risk tolerance. Smaller groups often choose $40,000-$75,000, while larger groups may select $100,000-$200,000 to reduce premiums.

How is aggregate stop-loss attachment calculated?

Aggregate attachment is typically 125% of expected claims. For example, if expected claims are $400,000, the aggregate attachment would be $500,000. Corridors range from 120% to 135% depending on the carrier and group risk profile.

Should I buy specific, aggregate, or both?

Most self-funded plans need both. Specific protects against individual catastrophic claims, while aggregate caps total annual exposure. Smaller groups especially need both layers of protection.

BART

Self-Funded Risk Management

Stop-Loss Insurance Calculator

Determine optimal stop-loss coverage for self-funded health plans. Analyze specific and aggregate deductible options to balance premium costs with risk protection.

What is Stop-Loss Insurance?

Stop-loss insurance protects self-funded employers from catastrophic claims that could exceed their financial capacity. It's essential risk management for any organization paying claims directly rather than through fully-insured premiums.

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Specific Stop-Loss

Individual claim protection

Protects against high-cost individual claimants. When a single person's claims exceed the specific deductible, stop-loss reimburses the excess.

Example

$75,000 specific deductible
Employee has $150,000 in claims
Employer pays: $75,000
Stop-loss pays: $75,000

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Aggregate Stop-Loss

Total claims protection

Caps total annual claim liability. When combined claims exceed the aggregate attachment point, stop-loss pays the excess.

Example

$500,000 aggregate (125% of $400K expected)
Total claims reach $600,000
Employer pays: $500,000
Stop-loss pays: $100,000

Specific Deductible Options

Deductible Level	Premium Impact	Employer Risk	Best For
$25,000	Highest	Lowest	Very risk-averse, small groups
$50,000	High	Low	Small groups (25-75 employees)
$75,000	Moderate-High	Low-Moderate	Mid-size groups (50-150)
$100,000	Moderate	Moderate	Common choice for 100+ groups
$150,000	Low-Moderate	Moderate-High	Larger, healthy groups
$200,000+	Lowest	Highest	Large groups with reserves

Aggregate Corridor Options

Corridor %	Employer Risk	Premium Impact	Notes
120%	Lowest	Highest	Maximum protection, minimum risk
125%	Low	Moderate	Most common corridor level
130%	Moderate	Low	Balance of cost and protection
135%	Higher	Lowest	Higher risk tolerance required

Key Stop-Loss Considerations

Lasering

Carriers may "laser" (increase deductible for) specific high-risk individuals. Review laser provisions carefully and negotiate alternatives.

No New Laser Guarantee

Some carriers offer protection against new lasers at renewal. This provides cost predictability for known conditions.

Terminal Liability

Coverage for claims incurred during the policy year but paid after termination. Critical for plan transitions.

Monthly Accommodation

How the aggregate attachment is spread monthly. 1/12 accommodation provides more protection early in the year.

Model Self-Funded Scenarios

BART helps you compare self-funded, level-funded, and fully-insured options with accurate cost projections.