| A | B |
|---|
| TPA | Most often this is the same as the plan administrator |
| Plan sponsor | The self-funded employer group |
| Stop Loss Insurance | Protects the employer group against claims beyond the expected amount |
| Specific Stop Loss | Limits employer's liability on claims to a certain dollar amount per claim on a particular member. |
| Aggregate Stop Loss | Limits employer's total liability to a percentage of expected claims payments. |
| Enrollees | Members of a TPA plan |
| ASO | Administrative Services Only |
| Administrative Services Agreement | An agreement between the employer and plan administrator on what the administrator will provide. |
| Agg Factors | Projects the maximum claim liability associated with the aggregate |
| Maximum Aggregate Reimbursement | The most the reinsurance will pay for claims that exceed the maximum claim liability. Often $1 Millon |
| Run in Limitation | Seen on a 15/12 contract basis to limit the amount that can be applied to stop loss. |
| Contract Basis | When claims can be incurred over when claims can be paid. Expressed as 12/12, 15/12, 12/24, etc. |
| Terminal funding liability | When a group cancels, this will fund the run out claims to be processed by the administrator for a period of time. |
| Mandated benefits | Benefits that must be covered according to the state. |
| ERISA | Federal law that protects the rights of insureds. |
| SPD | Document that provides enrollees with their rights and benefits. |
