[S144]

stop-loss provision

Health insurance policies that have coinsurance provisions require the insured to pay a portion of the loss after the deductible, e.g., 20% while the insurer pays the rest. In a large claim the insured could have a large out-of-pocket expense. The stop loss provisions will state that the insured will not have to pay any more of the loss once his/her out-of-pocket expense (including the deductible or not) has reached a certain limit, say $1,000.