X Individual Stop Loss Clause Samples

X Individual Stop Loss. BCBSNE will reimburse the Group for 100% of any excess over the Individual Stop Loss Amount, if, during the Contract Term, the total amount of eligible Net Paid Claims for any Covered Person exceeds the Individual Stop Loss Amount of $ See MGA and Attachments. This reimbursement will be made the month after such Individual Stop Loss Amount is exceeded. In addition, any final adjustment will be included following the end of the Contract Term, subject to the applicable stop loss reimbursement terms. The Individual Stop Loss Amount is subject to the Total Benefits maximum, if any, as indicated in the Benefit Plan Document. The Individual Stop Loss does not apply to claims incurred under dental coverage or coverage secondary or supplemental to Medicare, to expenses incurred for Covered Services over the Covered Person’s total benefits payable, or to ineligible claims. Claims eligible for reimbursement under Individual Stop Loss must be incurred within the Contract Term, as defined in the MGA and Attachments. Coverages eligible for Individual Stop Loss coverage include: X Medical claims X Prescription drug claims