POOLING LIMIT. The Group is liable for the accumulated paid Non-Capitated Claims of a Subscriber or Family Member up to the Pooling Limit, as set forth in the Schedule. Accumulation toward this Limit takes place over a period of twelve consecutive months, starting at the beginning of each Agreement Year. If, in any Agreement Year, the accumulated paid Non-Capitated Claims for a Subscriber or Family Member equal the Pooling Limit for that Agreement Year, the Group shall continue to be responsible for funding any further Non-Capitated Claims paid for that Subscriber or Family Member for that month and each subsequent month during the remainder of that Agreement Year. However, Anthem shall reimburse the Group in the amount of such further paid Non-Capitated Claims during the month immediately following the month in which the Non-Capitated Claims are paid. Anthem shall notify the Group when the Pooling Limit has been exceeded for a Subscriber or Family Member. Such notification shall be made one month following the month in which such Limit has been exceeded. Non-Capitated Claims incurred but not paid during an Agreement Year will accumulate toward the Pooling Limit for the subsequent Agreement Year. On the date the Agreement terminates, this Limit shall no longer apply. However, Non-Capitated Claims paid and applied to the Pooling Limit may be adjusted after the Agreement Year if Anthem recovers any overpayments, workers’ compensation or third party liability liens, as specified in Section XII. Anthem will recalculate the Non-Capitated Claims applied to the Pooling Limit and the Group will reimburse Anthem for any adjustments made over the Pooling Limit.
POOLING LIMIT. The liability of the Group under this section will not be subject to or limited by the Pooling Limit provisions of this endorsement.
POOLING LIMIT. The Pooling Limit for the Agreement Year is $400,000.00*. *This Limit does not apply to Dental Benefits or Prescription Drug Benefits, nor will claims paid on these benefits be applied toward the Pooling Limit. SCHEDULE MONTHLY ATTACHMENT POINT FACTORS Contract Types Monthly Attachment Point Factors Post-Termination Attachment Point Factors Composite Rate (per Subscriber) $ 509.37 $ 448.28 SUBSCRIPTION CHARGES The monthly Subscription Charges during the Agreement Year is $316.45 per Subscriber.
