Specific vs. Aggregate Stop-Loss Coverage
Stop-loss insurance comes in two forms that protect against different types of risk. Specific stop-loss protects against a single catastrophic claim. Aggregate stop-loss protects against a bad year across your entire population. Most self-funded employers need both.
Specific stop-loss: individual claim protection
Specific stop-loss (also called "individual stop-loss") kicks in when a single member's claims exceed your specific deductible in a plan year. The deductible is the amount you agree to pay per person before the carrier takes over. Common deductibles range from $50,000 to $250,000+ depending on group size and risk tolerance.
The specific deductible is the most important stop-loss decision you'll make. Set it too low and you pay excessive premiums. Set it too high and you're exposed to more risk than you can absorb. Use our stop-loss sizing calculator to model the right range for your group.
Aggregate stop-loss: total plan protection
Aggregate stop-loss caps your total plan liability for the year. The aggregate attachment point is typically set at 115–125% of expected annual claims. If total claims exceed this threshold, the carrier pays the excess.
Aggregate stop-loss is particularly important for smaller self-funded groups where a few bad claims can push total costs well above projections. For larger groups (500+), aggregate stop-loss is less critical because the law of large numbers provides more predictability.