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Stop Loss Provisions
This question was discussed in detail during the December 2020 episode of the BIF Bites podcast!
Todd has an unlimited major medical policy with a $350 deductible and 80/20 coinsurance to a $5,000 stop-loss. Todd has a claim of $10,000. How much must he pay out-of-pocket?
- $1,000
- $1,350
- $4,000
- $4,650
Correct answer: B. $1,350
Instructor insight:
The total claim is $10,000. This brings the policy over the stop-loss limit. The payments from the Insured and Insurer can be determined as follows:
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