Group Health Benefits Stop Loss Insurance
Stop Loss Insurance – Protection Against Catastrophic Medical Costs
Affordable, high-limit coverage for self-employed professionals, small business owners, and individuals without access to traditional group insurance.
What Is Stop Loss Insurance?
Stop Loss Insurance is a powerful financial safeguard designed to protect you from the devastating costs of a major illness or accident. Once you’ve paid a set deductible ($4,000), this policy covers eligible medical expenses up to $1,000,000 less the deductible, including hospital stays, rehabilitation, and prescription drugs. Whether you’re an entrepreneur, contractor, or high-risk worker, Stop Loss gives you peace of mind knowing that one unexpected medical event won’t wipe out your finances.
Key Benefits of Stop Loss Insurance
High Coverage Limit
Up to $1,000,000 annually after a one-time $4,000 deductible.
Covers Catastrophic Health Events
Major accidents, critical illness, hospitalizations.
Individual Coverage
Ideal for the self-employed or those without extended benefits.
Wide Range of Eligible Expenses
Hospital, rehab, prescriptions, equipment and more.
Works with HSAs
Complements a Health Spending Account for total health protection.
Predictable Costs
Fixed deductible with capped out-of-pocket exposure.
Eligibility
All active full-time employees of the participating employer, their spouses, and/or dependent children under age 75, who are Canadian citizens or landed immigrants with valid provincial health coverage. Employees must work a minimum of 20 hours per week and be actively at work when coverage starts.
Covered Medical Expenses
This plan reimburses eligible medical expenses that exceed the deductible, including hospital stays, diagnostic tests, prescription drugs, and other medically necessary services. All claims must be considered reasonable and customary as determined by the insurer.
Pre-Existing Conditions Exclusion
This policy does not cover medical expenses related to a condition that existed before coverage began. Specifically, coverage is excluded if:
- You received treatment, consultation, diagnostic services, or prescriptions for the condition within 6 months prior to coverage start; or
- You experienced symptoms for which a reasonable person would have sought medical care within the same timeframe; and
- You incur related medical expenses within 12 months of your effective date.
Exception: If the condition was covered under a previous plan with no lapse in coverage, this exclusion may not apply.
This is a summary of coverage only. Please see actual policy wording for complete details.
Legal & Underwriting Information
This coverage is underwritten by a global specialty insurer with a long-standing reputation for financial strength and claims reliability. This partner supports a wide range of innovative benefit solutions across Canada and around the world.
Ready to Get Covered?
If you’re interested in enhancing your HSA with Stop Loss protection, let’s connect to discuss how it works and what it could mean for your business.