Stop-Loss Insurance. At the discretion of the Departments of Banking and Insurance, Human Services, and Health and Senior Services and notwithstanding the requirements of N.J.A.C. 8:38-11.5 (b), the contractor may be required to obtain, prior to this contract, and maintain "stop-loss" insurance from a reinsurance company authorized to do business in New Jersey that will cover medical costs that exceed a threshold per case for the duration of the contract period. Any coverage other than stipulated must be based on an actuarial review, taking into account geographic and demographic factors, the nature of the clients, and state solvency safeguard requirements. All "stop-loss" insurance arrangements, including modifications, shall be reviewed and prior approved by the Departments of Banking and Insurance, Human Services, and Health and Senior Services. The "stop-loss" insurance underwriter must meet the standards of financial stability as set forth by the DOBI. Contractors with sufficient reserves may choose self-insurance, subject to approval by the Department of Human Services and the DOBI where appropriate.
Stop-Loss Insurance. In the event that the SRHCC determines to adopt a plan for medical, hospitalization, dental, prescription drug, or other insurance benefits under which each Participating Member is obligated to pay claims of its Covered Persons up to a predetermined level, the SRHCC shall purchase Stop-Loss Insurance Coverage on behalf of the Participating Members from an insurance company or companies licensed to do business in the State. That Stop-Loss Insurance Coverage shall obligate the insurance company to pay all amounts in excess of a predetermined, specified dollar amount (the “Stop-Loss Attachment Level”) with respect to aggregate claims and/or individual claims of all Covered Persons of all combined Participating Members in any one Fiscal Year.
Stop-Loss Insurance. Insurance purchased by CIRSA from an insurance company approved by the Insurance Commissioner to underwrite such coverage in Colorado providing certain coverage up to a contracted amount for otherwise uninsured losses to be borne by the loss fund, which in any one year aggregate to a pre-set maximum amount of coverage. Safer Together P: 800.228.7136 xxx.xxxxx.xxx
Stop-Loss Insurance. DHP shall assist DHS and SSMWI in obtaining such stop- loss or other like insurance as DHS and SSMWI may from time to time reasonably request in which case the cost of such insurance shall be paid by DHS or SSMWI, or out of the Capitation Pool Fund, as the case may be.
Stop-Loss Insurance. The CCN shall participate in a stop loss protection program in accordance with R.S. 22:452(1)(a) The CCN shall submit a copy of the third party reinsurance contract to DHH prior to its execution of this Provider Agreement and initial Medicaid enrollment.
Stop-Loss Insurance. Seller Parties shall use commercially reasonable efforts to cause its stop loss insurance carrier to fulfill any Stop-Loss Insurance obligations, as they exist prior to the Closing, relative to the Transferred Employees’ major medical coverage for the Transition Services Period. Continental shall pay Seller Parties the amounts paid by Seller Parties for the purpose of maintaining the Stop-Loss Insurance. The Seller Parties make no representation or warranty as to the availability of stop loss coverage and any risk that such coverage is not available shall be borne by the Buyer Parties.
Stop-Loss Insurance. PA HRM shall purchase and maintain in force during the term of this Agreement insurance to cover PA HRM's medical cost aggregate exposure above a level established by the parties from time to time (see Exhibit 2, II, (b)) on a Covered Member per month basis as a percentage of total DPW compensation for the period beginning as of the Effective Date and ending December 31, 1998, and for each calendar year thereafter during the term of this Agreement. This stop loss insurance shall cover PA HRM and Oxford from risk of excess medical costs and will also protect Oxford from losses flowing through PA HRM to Oxford. PA HRM shall notify Oxford immediately if said coverage has terminated or will terminate. Failure to maintain said coverage constitutes a material breach of this Agreement. Such coverage shall be with a carrier acceptable to Oxford. PA HRM shall provide evidence acceptable to Oxford that such coverage will be in force on the Effective Date.
Stop-Loss Insurance. Prior to the Closing Date, Seller agrees to use commercially reasonable efforts to shop for, and to the extent available, assist Purchaser in securing stop loss insurance coverage effective as of the Closing Date on Purchaser’s behalf to cover the self-insured welfare plans established by Purchaser effective as of the Closing Date pursuant to the Seller Transition Services Agreement. Purchaser shall be responsible for all of the costs associated with Seller’s efforts pursuant to the preceding sentence, and the stop loss insurance itself.
Stop-Loss Insurance. At the discretion of the Departments of Banking and Insurance, Human Services, and Health and Senior Services and notwithstanding the requirements of N.J.A.C. 8:38-11.5 (b), the contractor may be required to obtain, prior to this contract, and maintain "stop-loss" insurance from a reinsurance company authorized to do business in New Jersey that will cover medical costs that exceed a threshold per case for the duration of the contract period. Any coverage other than stipulated must be based on an actuarial review, taking into account geographic and demographic factors, the nature of the clients, and state solvency safeguard requirements. All "stop-loss" insurance arrangements, including modifications, shall be reviewed and prior approved by the Departments of Banking and Insurance, Human Services, and Health and Senior Services. The "stop-loss" insurance underwriter must meet the standards of financial stability as set forth by the DOBI.
Stop-Loss Insurance
