Stop Loss Coverage Sample Clauses

Stop Loss Coverage. During the term of this Agreement, Group shall either obtain professional stop loss coverage through Blue Shield under the terms and conditions set forth in Exhibit H attached hereto or shall obtain professional stop loss coverage from a third party insurer acceptable to Blue Shield. Upon request, certificates and other proof of such coverage shall be provided to Blue Shield. Group shall provide Blue Shield with timely notice of cancellation of coverage or change in carrier. If Group elects to have Blue Shield provide such stop loss coverage, by so indicating on the Signature Page hereto, Blue Shield shall provide and charge Group for stop loss coverage as set forth in Exhibit H.
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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.
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Stop Loss Coverage. (Check the applicable provisions for A. and B.)
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Stop Loss Coverage. Stop-Loss Fund
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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.
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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...
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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.
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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.
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Related to Stop Loss Coverage

  • Class Coverage Teachers, including but not limited to classroom teachers, special area teachers, and clinicians, shall not be required to take another teacher’s classes except in an emergency. Examples of an emergency are the following: a sudden illness of a teacher during the school day, or awaiting the arrival of an obtained substitute, and other situations mutually accepted by the teacher and the principal.

  • Workers’ Compensation and Employer’s Liability Coverage The insurer shall agree to waive all rights of subrogation against the City, its directors, officials, officers, employees, agents and volunteers for losses paid under the terms of the insurance policy which arise from work performed by the Consultant.

  • Automobile Liability Coverage Consultant shall maintain automobile liability insurance covering bodily injury and property damage for all activities of the Consultant arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and non- owned vehicles, in an amount of not less than one million dollars ($1,000,000) combined single limit for each occurrence.

  • Workers' compensation and employer's liability insurance endorsements The following are required: (i) CANCELLATION endorsement which provides that the District is entitled to 30 days prior written notice of cancellation or nonrenewal of the policy, or reduction in coverage, by certified mail, return receipt requested. (ii) WAIVER OF SUBROGATION endorsement which provides that the insurer will waive its right of subrogation against the District, its Trustees, and their officials, employees, volunteers, and agents with respect to any losses paid under the terms of the workers' compensation and employer's liability insurance policy which arise from work performed by the Named Insured for the District.

  • ’ Compensation and Employer’s Liability Coverage The Grantee shall provide workers’ compensation, in accordance with Chapter 440, F.S. and employer liability coverage with minimum limits of $100,000 per accident, $100,000 per person, and $500,000 policy aggregate. Such policies shall cover all employees engaged in any work under the Grant.

  • Worker's Compensation and Employer's Liability Insurance The Contractor shall have in effect during the entire life of this Agreement Workers' Compensation and Employer's Liability Insurance providing full statutory coverage. In signing this Agreement, the Contractor certifies, as required by Section 1861 of the California Labor Code, that it is aware of the provisions of Section 3700 of the California Labor Code which requires every employer to be insured against liability for Worker's Compensation or to undertake self-insurance in accordance with the provisions of the Code, and I will comply with such provisions before commencing the performance of the work of this Agreement.

  • PROFESSIONAL LIABILITY AND CYBER LIABILITY INSURANCE COVERAGE In addition to the insurance required in Attachment C to this Contract, before commencing work on this Contract and throughout the term of this Contract, Contractor agrees to procure and maintain (a) Technology Professional Liability insurance for any and all services performed under this Contract, with minimum third party coverage of $1,000,000.00 per claim, $2,000,000.00 aggregate. To the extent Contractor has access to, processes, handles, collects, transmits, stores or otherwise deals with State Data, Contractor shall maintain first party Breach Notification Coverage of not less than $1,000,000.00. Before commencing work on this Contract the Contractor must provide certificates of insurance to show that the foregoing minimum coverages are in effect. With respect to the first party Breach Notification Coverage, Contractor shall name the State of Vermont and its officers and employees as additional insureds for liability arising out of this Contract.

  • General Liability Coverage The CONTRACTOR shall maintain commercial general liability insurance in an amount of not less than one million dollars ($1,000,000) per occurrence for bodily injury, personal injury, and property damage. If a commercial general liability insurance form or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Agreement or the general aggregate limit shall be at least twice the required occurrence limit.

  • Exclusions from Coverage The Long-Term Disability Plan does not cover total disabilities resulting from: A) war, insurrection, rebellion, or service in the armed forces of any country; B) voluntary participation in a riot or civil commotion, except while an employee is in the course of performing the duties of her regular occupation; C) intentionally self-inflicted injuries or illness.

  • Commercial General Liability and Automobile Liability Coverages a. The City of San Xxxx, its officers, employees, agents and contractors are to be covered as additional insureds as respects: Liability arising out of activities performed by or on behalf of, GRANTEE; products and completed operations of GRANTEE; premises owned, leased or used by GRANTEE; and automobiles owned, leased, hired or borrowed by GRANTEE. The coverage shall contain no special limitations on the scope of protection afforded to CITY, its officers, employees, agents and contractors. b. GRANTEE's insurance coverage shall be primary insurance as respects CITY, its officers, employees, agents and contractors. Any insurance or self-insurance maintained by CITY, its officers, employees, agents or contractors shall be excess of GRANTEE's insurance and shall not contribute with it. c. Any failure to comply with reporting provisions of the policies by GRANTEE shall not affect coverage provided CITY, its officers, employees, agents, or contractors. d. Coverage shall state that GRANTEE's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. e. Coverage shall contain waiver of subrogation in favor of the City of San Xxxx, its officers, employees, agents and contractors.

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