A method of integrating benefits payable for the same patient under more than one plan. Benefits from all sources should not exceed 100% of the total charges.
A benefit plan in which the plan sponsor bears the entire risk of utilization. Some plans may be partially self-funded, if the sponsor employs indemnified stop-loss insurance to protect against the risk of unanticipated higher utilization. Third party administrators may provide claims processing and other administrative services, without bearing any of the risk of utilization of the plan.