Self-Funded Risk Management
Stop-loss insurance calculator
Enter expected annual claims, a quoted specific deductible and an aggregate corridor to model employer exposure. This free calculator shows the arithmetic; selecting coverage requires the complete carrier terms.
Calculator
Set the attachment points and see the exposure.
Specific stop-loss caps one claimant. Aggregate caps the year. Both matter, and they answer different questions.
$500,000
Aggregate attachment point
$41,667
Annual attachment ÷ 12
$75,000
Employer pays on that claimant
$75,000
Stop-loss pays on that claimant
How this is calculated
The annual aggregate attachment is $6,667 per enrolled employee across 75 employees. Changing enrollment changes this per-employee equivalent; the quoted group claims assumptions remain separate.
The aggregate attachment point is expected claims at the corridor you chose (125%), which leaves $100,000 of claims above expectation that the employer carries before that attachment point. The monthly figure divides the annual attachment by twelve for comparison. It does not establish a carrier’s monthly accommodation or reimbursement schedule; check the quoted contract.
On a single claimant, the employer pays up to the specific deductible of $75,000 and stop-loss pays the excess in this simplified covered-claim scenario.
Excluded: lasers on known claimants, terminal liability, run-in and run-out, and the contract basis (12/12 against 12/15), each of which moves real exposure. An estimate for planning, computed in your browser.
Worked example
What do $400,000 in expected claims and a 125% corridor mean?
These fictional figures match the calculator’s starting values. Change them to the terms you are comparing. No account or email is needed to use the calculator.
Inputs
- Expected annual claims: $400,000.
- Specific deductible: $75,000.
- Aggregate corridor: 125%.
- Enrolled employees: 75.
- One claimant’s annual claims: $150,000.
Calculated outputs
- Aggregate attachment: $400,000 × 1.25 = $500,000.
- Claims above expectation before that attachment: $100,000.
- Annual attachment divided by 12: about $41,667 per month.
- On the $150,000 claimant: $75,000 below the specific deductible and $75,000 above it.
This is an exposure illustration, not a premium quote, a coverage recommendation or a guarantee of reimbursement. It excludes fees, stop-loss premiums, lasers, exclusions and contract timing. Dividing the annual attachment by 12 does not establish a carrier’s monthly accommodation provision. Check the actual policy and quote.
Review contract terms that can change the exposure before preparing the client comparison.
What is stop-loss insurance?
Stop-loss insurance protects self-funded employers from catastrophic claims that could exceed their financial capacity. It's essential risk management for any organization paying claims directly rather than through fully-insured premiums.
Level-funded plans bundle stop-loss with a fixed monthly payment; level-funded plans explained covers how that works, and the level-funded stop-loss terms guide goes through lasers, run-out and terminal liability clause by clause. To weigh the whole self-funded budget against a fully insured renewal, use the self-funded vs fully insured calculator.
Specific stop-loss
Individual claim protection
Protects against high-cost individual claimants. When a single person's claims exceed the specific deductible, stop-loss reimburses the excess.
Employee has $150,000 in claims
Employer pays: $75,000
Stop-loss pays: $75,000
Aggregate stop-loss
Total claims protection
Caps total annual claim liability. When combined claims exceed the aggregate attachment point, stop-loss pays the excess.
Total claims reach $600,000
Employer pays: $500,000
Stop-loss pays: $100,000
Specific deductible options
| Deductible Level | Premium Impact | Employer Risk | Best For |
|---|---|---|---|
| $25,000 | Highest | Lowest | Very risk-averse, small groups |
| $50,000 | High | Low | Small groups (25-75 employees) |
| $75,000 | Moderate-High | Low-Moderate | Mid-size groups (50-150) |
| $100,000 | Moderate | Moderate | Common choice for 100+ groups |
| $150,000 | Low-Moderate | Moderate-High | Larger, healthy groups |
| $200,000+ | Lowest | Highest | Large groups with reserves |
Aggregate corridor options
| Corridor % | Employer Risk | Premium Impact | Notes |
|---|---|---|---|
| 120% | Lowest | Highest | Maximum protection, minimum risk |
| 125% | Low | Moderate | Most common corridor level |
| 130% | Moderate | Low | Balance of cost and protection |
| 135% | Higher | Lowest | Higher risk tolerance required |
Key stop-loss considerations
Lasering
Carriers may "laser" (increase deductible for) specific high-risk individuals. Review laser provisions carefully and negotiate alternatives.
No new laser guarantee
Some carriers offer protection against new lasers at renewal. This provides cost predictability for known conditions.
Terminal liability
Coverage for claims incurred during the policy year but paid after termination. Critical for plan transitions.
Monthly accommodation
How the aggregate attachment is spread monthly. 1/12 accommodation provides more protection early in the year.
Model self-funded scenarios
Planlined helps you compare self-funded, level-funded and fully insured quotes side by side, with renewal analysis and scenario modeling on the case's own rates. Check every figure against the carrier terms before presenting.
Frequently asked questions
What is the typical specific stop-loss deductible?
Specific deductibles typically range from $25,000 to $250,000+ depending on group size and risk tolerance. Smaller groups often choose $40,000-$75,000, while larger groups may select $100,000-$200,000 to reduce premiums.
How is aggregate stop-loss attachment calculated?
Aggregate attachment is typically 125% of expected claims. For example, if expected claims are $400,000, the aggregate attachment would be $500,000. Corridors range from 120% to 135% depending on the carrier and group risk profile.
Should I buy specific, aggregate, or both?
Most self-funded plans need both. Specific protects against individual catastrophic claims, while aggregate caps total annual exposure. Smaller groups especially need both layers of protection.