Contract Options

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SPECIFIC COVERAGE

Specific Stop Loss coverage is designed to limit the employer’s cost for eligible medical expenses per covered individual. It allows self-funded employers to protect themselves from catastrophic claims exceeding the deductible level. The specific deductible is selected based on the size of the group, the employer’s capacity to assume risk, as well as the medical claims experience of the plan. Once the specific deductible is exceeded, the Carrier will reimburse the employer for all eligible expenses.

CONTRACT OPTIONS

I.
Incurred and Paid (12/12)

Eligible Claims will be covered that are in excess of the group’s Specific Attachment Point and are:

  1. Incurred during the contract Period, and

  2. Paid during the Contract Period
II.
Incurred and Paid with a three month run-in provision (15/12)

Eligible Claims will be covered that are in excess of the group’s Specific Attachment Point and are:

  1. Incurred during the Contract Period, or within three months prior to the beginning of the Contract Period, and
  2. Paid during the Contract Period
III.
Incurred and Paid with a six month run-in provision (18/12)

Eligible Claims will be covered that are in excess of the group’s Specific Attachment Point and are:

  1. Incurred during the Contract Period, or within six months prior to the beginning of the Contract Period, and
  2. Paid during the Contract Period
IV.
Incurred and Paid with a twelve month run-in provision (24/12)

Eligible Claims will be covered that are in excess of the group’s Specific Attachment Point and are:

  1. Incurred during the Contract Period, or within twelve months prior to the beginning of the Contract Period, and
  2. Paid during the Contract Period
V.
Paid

Eligible Claims will be covered that are in excess of the group’s Specific Attachment Point and are:

  1. Incurred during the Contract Period, or within 12 months prior to the group’s original effective date with SLG Benefits.
  2. Paid during the Contract Period
VI.
 Incurred in the Contract Period and Paid in the Contract Period plus three months (12/15)

Eligible Claims will be covered that are in excess of the group’s Specific Attachment Point and are:

  1. Incurred during the Contract Period, and
  2. Paid during the Contract Period or within three months thereafter
VII.
Incurred in the Contract Period and Paid in the Contract Period plus six months (12/18)

Eligible Claims will be covered that are in excess of the group’s Specific Attachment Point and are:

  1. Incurred during the Contract Period, and
  2. Paid during the Contract Period or within six months thereafter
VIII.
Incurred in the Contract Period and Paid in the Contract Period plus three months (12/24)

Eligible Claims will be covered that are in excess of the group’s Specific Attachment Point and are:

  1. Incurred during the Contract Period, and
  2. Paid during the Contract Period or within twelve months thereafter
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