Specific Stop-Loss. Subject to Section 3.2 below, Company shall pay the Plan Sponsor any Loss paid during the term of this Agreement attributable to a Covered Individual that is in excess of the Specific Stop-Loss Limit.
Specific Stop-Loss. “Eligible Expenses” for purposes of the specific stop-loss coverage described in Section 3.1 of this Agreement means the benefits payable under the terms and conditions of the Plan as reflected in the Benefit Booklet and Summary Plan Description, attached hereto as Exhibit A, for health care services provided to Covered Individuals. Eligible Expenses do not include any capitated payments associated with providing such services. Capitated payments include, but are not limited to, Medical Value Payments. Medical payments are value-based payment arrangements with providers participating in certain health care delivery programs, including patient-centered medical homes, accountable care organizations or episode-based medical management. Eligible Expenses are subject to the exclusions / limitations in Section V of this Agreement. Specific Stop-Loss for: X Medical
Specific Stop-Loss. “Loss” or “Losses” for purposes of the specific stop-loss coverage described in Section 3.1 of this Agreement mean(s) Eligible Expenses that were incurred on or after 1/1/2016 and actually and validly paid during the term of this Agreement by the Plan; provided, however, “Loss” or “Losses” shall not include, in any manner whatsoever, any amounts paid for services/supplies that are not specifically covered under the terms of the Plan, court costs, interest upon judgments, any amount awarded claimants as punitive damages and/or legal expenses or attorney’s fees.
