What is stop-loss?
The maximum amount the insured would pay per calendar year. Example: If the insured has a 70/30% co-insurance and the maximum calendar year stop-loss is set at $1500 then the maximum amount the insured would pay is $1500. The medical plan tracks the 30% the insured is paying and once that amount reaches $1500 for that calendar year, the plan begins to pay at 100% for all charges incurred for the remainder of that calendar year.
