Short answer: Stop-loss insurance protects a self-funded employer from catastrophic claims. Specific (individual) stop-loss caps the plan’s exposure to any one person’s claims above a set deductible; aggregate stop-loss caps total claims for the whole group above an expected threshold.
Stop-loss is insurance for the plan, not for members: it reimburses the employer when claims exceed agreed limits. It comes in two forms:
Specific (individual) stop-loss protects against a single high-cost claimant. Once one person’s claims pass the specific deductible (the “attachment point”), the stop-loss carrier reimburses the plan for the excess.
Aggregate stop-loss protects against many moderate claims adding up. If total group claims exceed roughly 120–125% of expected (the aggregate attachment point), the carrier reimburses the excess.
Watch for “lasering” (a higher deductible assigned to a known high-cost individual) and contract terms like 12/12 vs. 12/15 (which claims and payments are covered), since they materially affect protection.
Sources
- Industry/secondary reference; TABA Self-Funded knowledge base (Stop-Loss). Verify specifics before CE use.
Content history
Originally published: June 16, 2026
Last reviewed: June 16, 2026