Stoploss 101

Group A enters into a 12/24 contract on 1/1/2022. What is the latest incurred date that is covered by the contract?

• 12/31/2021

• 12/31/2022

• 12/31/2023

• 12/31/2024

Company B enters into a 12/24 contract on 1/1/2022. What is the latest paid date covered by the contract?

• 12/31/2021

• 12/31/2022

• 12/31/2023

• 12/31/2024

Co. C has a $100k ISL.

2 employees have claims of $150K and $200K.

How much is Co. C reimbursed?

• $100,000

• $150,000

• $200,000

• $250,000

Group D has a $500 PEPM agg factor, 100 employees and a 25% corridor. What is their max annual attachment point?

• $750,000

• $62,500

• $150,000

• $600,000

Group E has a $500 PEPM agg factor, 100 employees, and a 25% corridor. What are their expected annual claims?

• $600,000

• $750,000

• $480,000

• $150,000

Stranger Co. enters into a 12/18 contract on 7/1/2022. What is a potential reason for wanting this contract?

• To cover runout claims incurred 6 months prior to the contract's start

• To cover runout claims paid within 6 months after the contract's end

• To cover runout claims incurred 6 months after the contract's end

• To cover runout claims paid 6 months before the contract's start

Co. A has $100k ISL and $50k Aggregating spec.

Two members have claims of $120k and $140k.

How much is Co. A reimbursed?

• $60,000

• $10,000

• $200,000

• $260,000

Deductible: $500

Coinsurance: 40%

OOP Max: $5,000

Claim $6,000

How much does the member pay?

• $2,700

• $2,200

• $5,000

• $500

Deductible: $500

Coinsurance: 40%

OOP Max: $5,000

Claim $6,000

How much does insurance pay?

• $3,300

• $3,800

• $5,000

• $4,500

Some Co. has $1M in expected claims and a 25% corridor.

Some Co.'s overall claims are $2M.

What is their reimbursement?

• $0

• $750,000

• $1 Million

• $1.25 Million