Stop-Loss Insurance Cost Calculator

A stop-loss insurance calculator estimates the cost of specific and aggregate stop-loss policies that protect self-funded employer health plans from catastrophic claims, factoring in attachment points, employee count, and any lasered high-cost individuals.

Specific vs Aggregate Stop-Loss

Specific stop-loss reimburses the plan for any single individual's claims above an attachment point (typically $50,000-$250,000). Aggregate stop-loss caps total plan exposure at a percentage (usually 120-125%) of expected claims. Together they convert a fully self-funded plan from unlimited risk to a capped exposure similar to a fully insured plan, but at 8-15% lower total cost (source: shrm.org).

Lasering — Carving Out High-Cost Individuals

When renewing stop-loss, carriers may 'laser' specific high-cost employees — assigning them an elevated attachment point (2-5× the plan's default). For example, an employee with a known $200,000 ongoing claim may get a $300,000 attachment while the rest of the plan stays at $75,000. Lasering keeps the overall premium competitive but transfers more risk back to the employer for those individuals.

Self-Funding Break-Even — When Stop-Loss Makes Sense

Self-funding with stop-loss typically beats fully-insured plans for employers with 100+ employees. Below 100, the volatility risk on aggregate claims is too high. Between 100-500 employees, level-funded products (insurer-administered self-funding with built-in stop-loss) bridge the gap. ERISA preemption protects self-funded plans from most state-level mandates, providing additional cost advantage.

Last updated May 2026. Sources: SHRM Self-Funding, DOL ERISA.