Stop loss is normally a term used in self funded employer group health plans but I have heard the phrase used to describe traditional major medical plans as well.
Your stop loss is the point where (at least in theory) your liability for paying out of pocket ceases and the carrier pays 100% of future covered claims. This only works in a practical matter in the case of a high deductible health plan (HDHP) where eligible claims are covered at 100% once the deductible is satisfied.
If you have a copay plan you can satisfy your major medical deductible and then hit your out of pocket coinsurance limit (stop loss) but still be responsible for paying claims for doctor visits, Rx and other items.
.JPG){kind=avatar}
Your stop loss is the point where (at least in theory) your liability for paying out of pocket ceases and the carrier pays 100% of future covered claims. This only works in a practical matter in the case of a high deductible health plan (HDHP) where eligible claims are covered at 100% once the deductible is satisfied.
If you have a copay plan you can satisfy your major medical deductible and then hit your out of pocket coinsurance limit (stop loss) but still be responsible for paying claims for doctor visits, Rx and other items.