Sun Life's Aggregating Specific plan design provides a creative solution for self-funded employers that are able to reta
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STOP-LOSS
Aggregating Specific Sun Life’s Aggregating Specific plan design provides a creative solution for self-funded employers that are able to retain more risk in exchange for lower premiums.
How it works This product feature combines the principles of Specific and Aggregate deductibles. Here’s how the feature works: •
he Aggregating Specific deductible is simply an T additional deductible that must be met before we begin to pay Specific claims. The employer meets the deductible with claim amounts that exceed the Specific deductible.
•
he employer can meet the Aggregating Specific T deductible with one or a combination of several plan participant claims. Employers need to meet the Aggregating Specific deductible only once during the policy year. After that, we pay when bills exceed the Specific deductible.
met, the employer pays only up to $75,000 (the Specific deductible) on a single claim—we cover the rest. Meeting the Aggregating Specific deductible with several claims Let’s say an employer receives three claims, each with totals over the Specific deductible. In this case, subtract the Specific deductible from each bill. Apply the remainder to the Aggregating Specific deductible until it is satisfied (up to $60,000 in this example). Medical claimant
Specific bill
Applies to Aggregating Specific
Specific deductible
Bob
$ 80,000 -
$75,000
=
$ 5,000
Aggregating Specific example
Sue
$ 100,000 -
$75,000
=
$25,000
Assumptions • $75,000 Specific deductible
Tom
$ 120,000 -
$75,000
=
$45,000
•
$60,000 Aggregating Specific deductible
•
Aggregate deductible is irrelevant
Meeting the Aggregating Specific deductible with one claim • One claim over $135,000 •
E mployer meets the Aggregating Specific deductible through: $ 75,000 Specific deductible $ 60,000 Aggregating Specific deductible $ 135,000 Employer payment on claim. Aggregating Specific deductible is fully satisfied.
$75,000
Since the Aggregating Specific deductible is only $60,000, we pay $15,000 of Tom’s bill. Plus, since the Aggregating Specific deductible is met, our payments begin on all new claims as soon as the Specific deductible ($75,000) is satisfied.
We pay anything over $135,000 on this claim. Now that the Aggregating Specific deductible has been
To learn more, contact your Sun Life Stop-Loss Specialist. One Sun Life Executive Park Wellesley Hills, MA 02481 www.sunlife.com/us
GSLFL-270n
Group stop-loss insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 07-SL. In New York, group stop-loss insurance policies are underwritten by Sun Life and Health Insurance Company (U.S.) (Lansing, MI) under Policy Form Series 07-NYSL REV 7-12. Product offerings may not be available in all states and may vary depending on state laws and regulations. © 2018 Sun Life Assurance Company of Canada, Wellesley Hills, MA 02481. All rights reserved. Sun Life Financial and the globe symbol are registered trademarks of Sun Life Assurance Company of Canada. Visit us at www.sunlife.com/us. SLPC 21997 05/18 (exp. 05/20)
