Stop Loss Coverage Sample Clauses

Stop Loss Coverage. IPA shall provide and maintain a Stop-Loss program, at IPA expense, providing protection against excessive Part A and/or Part B costs for Members as required by any applicable state or federal laws, rules and regulations. The Stop-Loss program shall be funded directly by IPA, in its sole discretion, and not as a carve-out from the capitation allocated to the Part A and Part B Funds, with a stop loss insurance carrier on terms and conditions reasonably acceptable to IPA.

Stop Loss Coverage. The cost of any stop-loss coverage that is obtained by the Committee shall be included in the per capita charge that is assessed to Participating Employers.

Stop Loss Coverage. Guardian shall have the right to provide Contractholders with stop-loss insurance or reinsurance with respect to HMO Plans that are Managed Care Contracts subject to this Agreement. Guardian shall have the right to bid on stop-loss reinsurance protection for all other business of PHS. Nothing herein shall require PHS to reinsure HMO Plans that are not Managed Care Contracts with Guardian. In addition, Guardian acknowledges that PHS has certain existing arrangements, and may enter into additional arrangements in the future, for stop-loss reinsurance coverage for HMO Plans that are not Managed Care Contracts which shall remain in effect regardless of this Agreement.

Stop Loss Coverage. (Check the applicable provisions for A. and B.)

Stop Loss Coverage. A. BCBSND agrees to reimburse the Insured for Plan Benefits that exceed the Individual Stop-Loss Attachment Point and/or the greater of the Minimum Aggregate Deductible or the Aggregate Stop-Loss Attachment Point during a Contract Period only when and to the extent the Plan Benefits are actually paid. A Plan Benefit is deemed to have been paid as of the date the payment instrument issued by the Insured is tendered for payment and subsequently honored within a reasonable time. Benefits that are incurred other than during the Contract Period are not eligible for reimbursement under this Contract. B. BCBSND shall not have any responsibility or obligation under this Contract to directly reimburse or pay benefits to or on behalf of a Member or to any provider of services. This Contract is solely between BCBSND and the Insured and shall not create any rights or legal relationship between BCBSND and any Member or agent or assignee thereof. BCBSND's sole liability hereunder is to the Insured, subject to the terms, conditions and limitations of this Contract. It is the Insured's intent that the Insured shall be the sole beneficiary of this Contract so as to enable the Insured to stabilize funding of the Plan against losses in excess of the Individual Stop-Loss Attachment Point and/or the greater of the Minimum Aggregate Deductible or the Aggregate Stop-Loss Attachment Point set forth herein. The Insured is the Administrator of the Plan as defined at section 2(16)(A) of ERISA, with all of the duties and responsibilities applicable to plan administrators under ERISA, including but not necessarily limited to compliance with any and all administrative, reporting, and disclosure requirements. BCBSND is not the plan administrator and is not responsible for any of the duties assigned to the plan administrator by ERISA or by the terms of the Plan unless delegated to BCBSND by the terms of the Plan. C. BCBSND shall not reimburse the Insured for any loss or expense caused by or resulting from any of the following: 1. Expenses incurred while the Plan is not in effect with respect to the Member and/or while a Member is not eligible for coverage under the Plan; 2. Expenses that BCBSND, or an independent review organization pursuant to an applicable external review process under the Plan, determines are not covered under the terms of the Plan; 3. Expenses or losses covered by amendments to the Plan that are incurred prior to the effective date of BCBSND's written consent as desc...

Stop Loss Coverage. Stop-Loss Fund

Stop Loss Coverage. Employer has entered into a stop loss arrangement with a stop loss vendor. BlueCross’s duties with regard to this stop loss arrangement are set forth in Exhibit C.

Stop Loss Coverage. Customer shall be responsible for coordinating with the Medical Plan’s stop loss carrier and other service providers for the Medical Plan and informing such persons of any updates to the design of the Medical Plan due to the Clinical Services described in this Agreement.

Stop Loss Coverage. (a) As soon as administratively feasible following the written request of Buyer, Seller shall use commercially reasonable efforts to purchase, to the extent reasonably available in the market, a stop loss coverage insurance policy providing coverage to Seller with regard to benefits provided under the health and welfare Employee Benefit Plans of Seller for participants and beneficiaries whose coverage under such plan is on account of services provided to the Company, upon such terms (including attachment levels and early termination procedures) reasonably requested by the Buyer and subject to Buyer’s approval, which policy is expected to be effective as of January 1, 2020 and to continue, unless earlier terminated in accordance with the following sentence, through December 31, 2020 (not including any runoff period for incurred but not reported claims) (such policy the “Stop Loss Coverage”). Upon the request of the Buyer, Seller shall use commercially reasonable efforts to terminate the Stop Loss Coverage early to the extent permitted under the terms of the insurance contract. All premiums, brokerage fees and commissions payable for or in connection with, and all other reasonable and documented out-of-pocket costs and expenses incurred by Seller in connection with obtaining the Stop Loss Coverage shall be paid by the Buyer. Any payments made to Seller under the Stop Loss Coverage shall be treated as a payment by the Buyer to the Seller under Section 6.04 in furtherance of Buyer’s obligations to provide benefits coverage under such Section 6.04. (b) Notwithstanding anything to the contrary herein, (i) it is understood and agreed that (A) the condition precedent set forth in Section 8.01(b)(ii) as applied to Sellers’ obligations under this Section 6.12 shall be deemed to be satisfied and (B) Seller shall be entitled to exercise each of the termination rights applicable to it in Article 9 hereof (subject to the terms and conditions thereof), in each case, notwithstanding any breach of this ‎Section 6.12 by Seller, and (ii) Buyer acknowledges and agrees that obtaining the Stop Loss Coverage is not a condition to Closing.