{"id":2046,"date":"2025-11-27T12:12:14","date_gmt":"2025-11-27T17:12:14","guid":{"rendered":"https:\/\/johnstonesbenefits.com\/clients\/ila\/?p=2046"},"modified":"2025-10-27T12:12:28","modified_gmt":"2025-10-27T16:12:28","slug":"stop-loss-coverage","status":"publish","type":"post","link":"https:\/\/johnstonesbenefits.com\/clients\/ila\/stop-loss-coverage\/","title":{"rendered":"Stop Loss Coverage"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-2d9bbcf79d50a3601923aa8844f713a6\">\n#top .av-special-heading.av-av_heading-2d9bbcf79d50a3601923aa8844f713a6{\npadding-bottom:10px;\nfont-size:4vw;\n}\nbody .av-special-heading.av-av_heading-2d9bbcf79d50a3601923aa8844f713a6 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n#top #wrap_all .av-special-heading.av-av_heading-2d9bbcf79d50a3601923aa8844f713a6 .av-special-heading-tag{\nfont-size:4vw;\n}\n.av-special-heading.av-av_heading-2d9bbcf79d50a3601923aa8844f713a6 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-av_heading-2d9bbcf79d50a3601923aa8844f713a6 av-special-heading-h2 blockquote modern-quote  avia-builder-el-0  el_before_av_hr  avia-builder-el-first  av-inherit-size'><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >The Journal<\/h2><div class='av-subheading av-subheading_below'><p>Solid Group Plans Made Simple<\/p>\n<\/div><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div>\n<div  class='hr av-av_hr-f04ef840c2b66cff6c43fead44ee8d66 hr-default  avia-builder-el-1  el_after_av_heading  el_before_av_heading '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-mh9c4x5i-bc2b63be7a901073f5713d93b8028b7c\">\n#top .av-special-heading.av-mh9c4x5i-bc2b63be7a901073f5713d93b8028b7c{\npadding-bottom:10px;\ncolor:#c4a106;\nfont-size:3vw;\n}\nbody .av-special-heading.av-mh9c4x5i-bc2b63be7a901073f5713d93b8028b7c .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n#top #wrap_all .av-special-heading.av-mh9c4x5i-bc2b63be7a901073f5713d93b8028b7c .av-special-heading-tag{\nfont-size:3vw;\n}\n.av-special-heading.av-mh9c4x5i-bc2b63be7a901073f5713d93b8028b7c .special-heading-inner-border{\nborder-color:#c4a106;\n}\n.av-special-heading.av-mh9c4x5i-bc2b63be7a901073f5713d93b8028b7c .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-mh9c4x5i-bc2b63be7a901073f5713d93b8028b7c av-special-heading-h2 custom-color-heading blockquote modern-quote  avia-builder-el-2  el_after_av_hr  el_before_av_hr  av-inherit-size'><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >Stop Loss Coverage<\/h2><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_hr-8ddc7023771561a08c2d1878cbb01bdc\">\n#top .hr.hr-invisible.av-av_hr-8ddc7023771561a08c2d1878cbb01bdc{\nheight:30px;\n}\n<\/style>\n<div  class='hr av-av_hr-8ddc7023771561a08c2d1878cbb01bdc hr-invisible  avia-builder-el-3  el_after_av_heading  el_before_av_one_full '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_one_full-7688609b370c0fc22d37f41de2668996\">\n.flex_column.av-av_one_full-7688609b370c0fc22d37f41de2668996{\nborder-radius:0px 0px 0px 0px;\n-webkit-border-radius:0px 0px 0px 0px;\n-moz-border-radius:0px 0px 0px 0px;\n}\n<\/style>\n<div class='flex_column av-av_one_full-7688609b370c0fc22d37f41de2668996 av_one_full  avia-builder-el-4  el_after_av_hr  avia-builder-el-last  first flex_column_div av-zero-column-padding '   ><section  class='av_textblock_section av-mh9c5ov2-a8994ef880a98ddd14d23ae7e8f9876e'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><a href=\"https:\/\/johnstonesbenefits.com\/clients\/ila\/wp-content\/uploads\/2025\/10\/2025_11-Stop-Loss-Coverage.pdf\" target=\"_blank\" rel=\"noopener\">Click here to download pdf<\/a><\/p>\n<p>As part of your group benefits plan, your Extended Health Care (EHC) coverage includes a feature called Stop-Loss protection. This is an important safeguard designed to protect both your plan and your employees against the financial impact of very high-cost health claims.<\/p>\n<p><strong>What is Stop-Loss Coverage?<\/strong><\/p>\n<p>Stop-Loss coverage places a maximum limit on the amount your plan is responsible for on any single individual\u2019s eligible health claims in a calendar year. Once that limit (known as the stop-loss threshold) is reached, any amount claimed in excess of it will not be included in your renewal rate calculation.<\/p>\n<p>For most of our clients, the stop-loss level is $10,000 per person per year. Some plans have higher thresholds (e.g., $15,000 or $25,000), depending on plan size and funding arrangements.<\/p>\n<p><strong><em>Example:<\/em><\/strong><\/p>\n<p><em>If an employee or dependent has $75,000 in prescription drug claims in a year and your stop-loss level is $10,000, your plan would be responsible for the first $10,000. The remaining $65,000 would be covered by the insurer under the stop-loss provision.\u00a0 This structure ensures that one person\u2019s high claims don\u2019t negatively impact the long-term sustainability of the entire group plan.<\/em><\/p>\n<p><strong>Large Amount Pooling (LAP)<\/strong><\/p>\n<p>Stop-Loss protection is often referred to as Large Amount Pooling (LAP). Each insurer maintains a pooling arrangement that collects premiums from many groups to create a shared fund. This fund is used to pay for high-cost claims that exceed the stop-loss threshold.<\/p>\n<p>By pooling together, all participating employers share in the risk of large claims, which helps keep premiums more stable over time\u2014even if your own group experiences an unexpected high-cost claim.<\/p>\n<p><strong>Out-of-Country (OOC) Claims<\/strong><\/p>\n<p>Pooling\u00a0protection also applies to out-of-country medical emergencies, which can be among the most expensive types of claims. If an employee requires emergency medical treatment while travelling, the claim is processed through your\u00a0out of country pooling\u00a0coverage from 1st dollar of claim, rather than after the specified limit.\u00a0This helps ensure that major travel emergencies are covered without affecting your plan&#8217;s renewal rates or premium stability.<\/p>\n<p><strong>Why It Matters<\/strong><\/p>\n<p>In today\u2019s environment of rising prescription drug costs and advanced medical treatments, it\u2019s not uncommon for individual claims to reach hundreds of thousands of dollars. Stop-Loss protection:<\/p>\n<ul>\n<li>Shields your plan from catastrophic costs<\/li>\n<li>Helps maintain premium stability from year to year<\/li>\n<li>Ensures your employees continue to have access to vital care without jeopardizing the plan\u2019s sustainability<\/li>\n<\/ul>\n<p>In summary: Stop-Loss (LAP) coverage is a vital part of your group benefits plan, acting as financial protection against large and unexpected health claims.<\/p>\n<p>If you\u2019d like to review your plan\u2019s current stop-loss level, please let us know &#8211; we\u2019re happy to provide guidance.<\/p>\n<\/div><\/section><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-2046","post","type-post","status-publish","format-standard","hentry","category-news"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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