Stop-Loss

Transfer Calculation

$7,231.42 (CASE PAYMT RATE) × 0.8528 (SIW) = $8,479.62 ÷ 7 (AVERAGE LENGTH OF STAY) = $1,211.37 × 120% (TRANSFER ADJ FACTOR) = $1,453.65 + $96.33 (CAPITAL COST PER DIEM) = $1,549.98 × 3 days (LENGTH OF STAY) = $4,649.94 × 1.0704 (HCRA) = $4,977.29 (total transfer payment)

Stop-Loss would compare the inlier total, the transfer total, and the amount paid by the Plan; and reimburses the lower of three.