AGGREGATE STOP LOSS COVERAGE. The Aggregate Stop Loss Limit is the sum of the amounts derived by multiplying the applicable aggregate stop loss amount by the actual number of Subscribers or Members, provided in Section 5(B) of Schedule A, for all months in the Policy Period. In no event shall the Aggregate Stop Loss Limit fall below the Minimum Aggregate Stop Loss Limit during a Policy Period or a partial Policy Period. When the total amount of Paid Claims for all Subscribers or Members and the Lines of Coverage indicated in Sections 5(A) and 5(B) of Schedule A exceeds the Aggregate Stop Loss Limit, Anthem shall reimburse Employer for such excess. Anthem's reimbursement under this Article 3 shall occur no later than 90 days following the end of the Eligible Claim Date Period. All Lines of Coverage that are subject to aggregate stop loss coverage shall be combined for purposes of calculating amounts owed under this Policy. However, Anthem's reimbursement to Employer under this Article 3 shall be limited to the Aggregate Stop Loss Maximum less the greater of the Aggregate Stop Loss Limit or the Minimum Aggregate Stop Loss Limit for the Policy Period. Certain Paid Claims may be excluded from the aggregate stop loss coverage provided in this Policy. These exclusions are provided in Section 5(D) of Schedule A as applicable.
AGGREGATE STOP LOSS COVERAGE. Yes No If yes, complete items 1 through 9 below.
1. New Coverage Renewal of Existing Coverage
2. Stop Loss Coverage during the current Policy Period: New Coverage (Select one from below): Incurred and paid during the Policy Period: Claims incurred and paid from to Incurred with Run-Out: Run-in coverage: Claims incurred from to and Claims paid from to Claims incurred from to and Claims paid from to If coverage is for claims incurred prior to the effective date of the Policy and paid by Policyholder’s prior claim administrator, then such claims must be reported by the Policyholder to the Company (Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company) and paid by the Policyholder’s prior claim administrator by the end of the current Policy Period. Renewal of Existing Coverage: Claim Administrator’s Claims: Claims incurred on or after the original Effective Date of Agreement and paid during the Policy Period.
3. Aggregate Stop Loss Coverage shall apply to: Medical Claims Outpatient Prescription Drug Claims with Company’s Pharmacy Benefit Manager Outpatient Prescription Drug Claims with Policyholder’s Pharmacy Benefit Manager: Dental Claims Other (please specify):
