Self-funded employers use two types of stop-loss insurance: specific stop-loss caps individual claims (say $25,000 per person), while aggregate stop-loss caps total claims across the whole group. Both protect against different risks, like one expensive case versus several high-cost claims hitting at once.
There are two different types of stop loss. One is called specific stop loss, the other is called aggregate. So specific is exactly what it says. It looks at a specific person. Okay. So, and you can pick when you look at self-funding what you want that specific to be. If you want it to be $25,000, then you would be on the hook for the first $25,000 of anybody's claims. If you want it to be $100,000, you would be on the hook for the first $100,000. And then the aggregate protection That is as a whole. So if something happens and you have 3 preemies in your group that each, you know, had their specific hits, you know, a lot of— if a lot of people hit that specific, it could be ugly as well. So you— the aggregate protects everybody as a whole.
