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🛡️ '''Employer stop-loss insurance''' is a [[Definition:Reinsurance | reinsurance]]-like product purchased by employers that [[Definition:Self-insured plan | self-fund]] their employee [[Definition:Health insurance | health benefit]] plans, designed to cap the employer's financial exposure when [[Definition:Claims | claims]] exceed predetermined thresholds. Unlike fully insured [[Definition:Group insurance | group plans]]—where a carrier assumes all claim risk in exchange for a fixed [[Definition:Premium | premium]]—self-funded arrangements leave the employer responsible for paying claims directly, with stop-loss coverage serving as the financial safety net that makes self-funding viable.

🔧 Stop-loss protection comes in two forms. [[Definition:Specific stop-loss | Specific stop-loss]] (also called individual stop-loss) reimburses the employer when any single covered individual's claims surpass a set dollar amount, known as the [[Definition:Attachment point | attachment point]] or specific deductible. [[Definition:Aggregate stop-loss | Aggregate stop-loss]] kicks in when total plan claims for the entire group exceed a corridor—typically set as a percentage above expected claims. [[Definition:Underwriter | Underwriters]] at stop-loss carriers analyze the employer's [[Definition:Census data | census data]], historical [[Definition:Claims experience | claims experience]], and [[Definition:Large claim | large-claim]] history to price both layers, setting attachment points and premiums that reflect the group's unique [[Definition:Risk profile | risk profile]]. [[Definition:Third-party administrator (TPA) | TPAs]] often coordinate claims reporting to ensure stop-loss recoveries are triggered promptly.

📊 This product occupies a critical niche in the benefits market. Self-funding has grown steadily, particularly among mid-size and large employers seeking greater control over plan design, [[Definition:Cash flow | cash flow]], and [[Definition:Claims data | claims data]]. Without stop-loss protection, a handful of catastrophic claims—organ transplants, premature births, specialty drug regimens—could devastate an employer's finances. For [[Definition:Broker | brokers]], structuring the right stop-loss program is one of the most consequential decisions in a self-funded client's benefits strategy. Carriers in this space compete on attachment-point flexibility, [[Definition:Claims turnaround time | claims turnaround]], and the breadth of conditions covered, making employer stop-loss one of the more dynamic segments in group health [[Definition:Underwriting | underwriting]].

'''Related concepts:'''
{{Div col|colwidth=20em}}
* [[Definition:Self-insured plan]]
* [[Definition:Specific stop-loss]]
* [[Definition:Aggregate stop-loss]]
* [[Definition:Attachment point]]
* [[Definition:Third-party administrator (TPA)]]
* [[Definition:Group insurance]]
{{Div col end}}

Definition:Employer stop-loss insurance - Revision history

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