X Individual Stop Loss Sample Clauses

X Individual Stop Loss. BCBSNE will reimburse the Group for 100% of any excess over the Individual Stop Loss Amount, if, during the Contract Term, the total amount of eligible Net Paid Claims for any Covered Person exceeds the Individual Stop Loss Amount of $ See MGA and Attachments. This reimbursement will be made the month after such Individual Stop Loss Amount is exceeded. In addition, any final adjustment will be included following the end of the Contract Term, subject to the applicable stop loss reimbursement terms. The Individual Stop Loss Amount is subject to the Total Benefits maximum, if any, as indicated in the Benefit Plan Document. The Individual Stop Loss does not apply to claims incurred under dental coverage or coverage secondary or supplemental to Medicare, to expenses incurred for Covered Services over the Covered Person’s total benefits payable, or to ineligible claims. Claims eligible for reimbursement under Individual Stop Loss must be incurred within the Contract Term, as defined in the MGA and Attachments. Coverages eligible for Individual Stop Loss coverage include: X Medical claims X Prescription drug claims
AutoNDA by SimpleDocs

Related to X Individual Stop Loss

  • Preexisting Individual Accounts The following rules and procedures apply for purposes of identifying U.S. Reportable Accounts among Preexisting Accounts held by individuals (“Preexisting Individual Accounts”).

  • Are My Contributions to a Traditional IRA Tax Deductible Although you may make a contribution to a Traditional IRA within the limitations described above, all or a portion of your contribution may be nondeductible. No deduction is allowed for a rollover contribution (including a “direct rollover”) or transfer. For “regular” contributions, the taxability of your contribution depends upon your tax filing status, whether you (and in some cases your spouse) are an “active participant” in an employer-sponsored retirement plan, and your income level. An employer-sponsored retirement plan includes any of the following types of retirement plans: • a qualified pension, profit-sharing, or stock bonus plan established in accordance with IRC 401(a) or 401(k); • a Simplified Employee Pension Plan (SEP) (IRC 408(k)); • a deferred compensation plan maintained by a governmental unit or agency; • tax-sheltered annuities and custodial accounts (IRC 403(b) and 403(b)(7)); • a qualified annuity plan under IRC Section 403(a); or • a Savings Incentive Match Plan for Employees of Small Employers (SIMPLE Plan). Generally, you are considered an “active participant” in a defined contribution plan if an employer contribution or forfeiture was credited to your account during the year. You are considered an “active participant” in a defined benefit plan if you are eligible to participate in a plan, even though you elect not to participate. You are also treated as an “active participant” if you make a voluntary or mandatory contribution to any type of plan, even if your employer makes no contribution to the plan. If you are not married (including a taxpayer filing under the “head of household” status), the following rules apply: • If you are not an “active participant” in an employer- sponsored retirement plan, you may make a contribution to a Traditional IRA (up to the contribution limits detailed in Section 3). • If you are single and you are an “active participant” in an employer-sponsored retirement plan, you may make a fully deductible contribution to a Traditional IRA (up to the contribution limits detailed in Section 3), but then the deductibility limits of a contribution are related to your Modified Adjusted Gross Income (AGI) as follows: Year Eligible to Make a Deductible Contribution if AGI is Less Than or Equal to: Eligible to Make a Partially Deductible Contribution if AGI is Between: Not Eligible to Make a Deductible Contribution if AGI is Over: 2020 $65,000 $65,000 - $75,000 $75,000 2021 & After - subject to COLA increases $66,000 $66,000 - $76,000 $76,000 If you are married, the following rules apply: • If you and your spouse file a joint tax return and neither you nor your spouse is an “active participant” in an employer-sponsored retirement plan, you and your spouse may make a fully deductible contribution to a Traditional IRA (up to the contribution limits detailed in Section 3). • If you and your spouse file a joint tax return and both you and your spouse are “active participants” in employer- sponsored retirement plans, you and your spouse may make fully deductible contributions to a Traditional IRA (up to the contribution limits detailed in Section 3), but then the deductibility limits of a contribution are as follows: Year Eligible to Make a Deductible Contribution if AGI is Less Than or Equal to: Eligible to Make a Partially Deductible Contribution if AGI is Between: Not Eligible to Make a Deductible Contribution if AGI is Over: 2020 $104,000 $104,000 - $124,000 $124,000 2021 & After - subject to COLA increases $105,000 $105,000 - $125,000 $125,000 • If you and your spouse file a joint tax return and only one of you is an “active participant” in an employer- sponsored retirement plan, special rules apply. If your spouse is the “active participant,” a fully deductible contribution can be made to your IRA (up to the contribution limits detailed in Section 3) if your combined modified adjusted gross income does not exceed $196,000 in 2020 or $198,000 in 2021. If your combined modified adjusted gross income is between $196,000 and $206,000 in 2020, or $198,000 and $208,000 in 2021, your deduction will be limited as described below. If your combined modified adjusted gross income exceeds $206,000 in 2020 or $208,000 in 2021, your contribution will not be deductible. Your spouse, as an “active participant” in an employer- sponsored retirement plan, may make a fully deductible contribution to a Traditional IRA if your combined modified adjusted gross income does not exceed the amounts listed in the table above. Conversely, if you are an “active” participant” and your spouse is not, a contribution to your Traditional IRA will be deductible if your combined modified adjusted gross income does not exceed the amounts listed above. • If you are married and file a separate return, and neither you nor your spouse is an “active participant” in an employer-sponsored retirement plan, you may make a fully deductible contribution to a Traditional IRA (up to the contribution limits detailed in Section 3). If you are married, filing separately, and either you or your spouse is an “active participant” in an employer-sponsored retirement plan, you may not make a fully deductible contribution to a Traditional IRA. Please note that the deduction limits are not the same as the contribution limits. You can contribute to your Traditional IRA in any amount up to the contribution limits detailed in Section 3. The amount of your contribution that is deductible for federal income tax purposes is based upon the rules described in this section. If you (or where applicable, your spouse) are an “active participant” in an employer- sponsored retirement plan, you can refer to IRS Publication 590-A: Figuring Your Modified AGI and Figuring Your Reduced IRA Deduction to calculate whether your contribution will be fully or partially deductible. Even if your income exceeds the limits described above, you may make a contribution to your IRA up to the contribution limitations described in Section 3. To the extent that your contribution exceeds the deductible limits, it will be nondeductible. However, earnings on all IRA contributions are tax deferred until distribution. You must designate on your federal income tax return the amount of your Traditional IRA contribution that is nondeductible and provide certain additional information concerning nondeductible contributions. Overstating the amount of nondeductible contributions will generally subject you to a penalty of $100 for each overstatement.

  • Multiple Individual Retirement Accounts In the event the depositor maintains more than one Individual Retirement Account (as defined in Section 408(a)) and elects to satisfy his or her minimum distribution requirements described in Article IV above by making a distribution from another individual retirement account in accordance with Item 6 thereof, the depositor shall be deemed to have elected to calculate the amount of his or her minimum distribution under this custodial account in the same manner as under the Individual Retirement Account from which the distribution is made.

  • How Are Distributions From a Traditional IRA Taxed for Federal Income Tax Purposes Amounts distributed to you are generally includable in your gross income in the taxable year you receive them and are taxable as ordinary income. To the extent, however, that any part of a distribution constitutes a return of your nondeductible contributions, it will not be included in your income. The amount of any distribution excludable from income is the portion that bears the same ratio as your aggregate non-deductible contributions bear to the balance of your Traditional IRA at the end of the year (calculated after adding back distributions during the year). For this purpose, all of your Traditional IRAs are treated as a single Traditional IRA. Furthermore, all distributions from a Traditional IRA during a taxable year are to be treated as one distribution. The aggregate amount of distributions excludable from income for all years cannot exceed the aggregate non-deductible contributions for all calendar years. You must elect the withholding treatment of your distribution, as described in paragraph 22 below. No distribution to you or anyone else from a Traditional IRA can qualify for capital gains treatment under the federal income tax laws. Similarly, you are not entitled to the special five- or ten-year averaging rule for lump-sum distributions that may be available to persons receiving distributions from certain other types of retirement plans. Historically, so-called “excess distributions” to you as well as “excess accumulations” remaining in your account as of your date of death were subject to additional taxes. These additional taxes no longer apply. Any distribution that is properly rolled over will not be includable in your gross income.

  • When Must Distributions from a Traditional IRA Begin You must begin receiving the assets in your account no later than April 1 following the calendar year in which you reach RMD age.

  • How do the RMD Rules Impact my Designated Beneficiary or Beneficiaries The RMD rules provide for the determination of your designated beneficiary or beneficiaries as of September 30 of the year following your death. Consequently, any beneficiary may be eliminated for purposes of calculating the RMD by the distribution of that beneficiary’s benefit, through a valid disclaimer between your death and the end of September following the year of your death, or by dividing your IRA account into separate accounts for each of several designated beneficiaries you may have designated.

  • Medical Insurance for Retirees The University will make available a medical insurance plan for official retirees hired prior to January 1, 2014 in the same manner and on the same basis as applies to all the University’s other official retirees. An official retiree (including early retirees) for purposes of this benefit, will be defined as any regular employee who is employed by the University at the time of retirement, who is vested in a University sponsored retirement plan and whose years of University service and age total a minimum of 75. Coverage for the spouse of the retiree or early retiree is available on the same basis as for other University official retirees. The University retains the right to modify or terminate this plan upon reasonable notice to staff and retirees.

  • Traditional Individual Retirement Custodial Account The following constitutes an agreement establishing an Individual Retirement Account (under Section 408(a) of the Internal Revenue Code) between the depositor and the Custodian.

  • Five-Tier Copayment Structure This prescription drug plan formulary has a five-tiered copayment structure. The copayment for a prescription drug will vary by tier. The tier placement of a prescription drug on our formulary is subject to change. For more information about our formulary, and to see the tier placement of a particular prescription drug, visit our website or call our Customer Service Department. Below indicates the tier structure for this plan and the amount that you are responsible to pay. You will be responsible for paying the lowest cost of either your copayment, the retail cost of the drug, or the pharmacy allowance. We reserve the right not to accept manufacturer coupons, discount plan payments or other cost share assistance program payments for prescription drug copayments and/or deductibles. Insulin Prescription Drugs In accordance with RIGL § 27-20.8-3, copayments for insulin prescription drugs will not exceed $40 for each thirty-day supply and are not subject to a deductible. Summary of Pharmacy Benefits Covered Benefits Network Pharmacy Non-network Pharmacy (+) Preauthorization is required for thisservice. Please see Preauthorization in Section 3 for more information. You Pay You Pay Prescription Drugs, other than Specialty Prescription Drugs, and Diabetic Equipment and Supplies (which includes Glucometers, Test Strips, Lancet and Lancet Devices, Needles and Syringes, and Miscellaneous Supplies, calibration fluid): When purchased at a Retail Pharmacy: For maintenance and non-maintenance prescription drugs, a copayment applies for each 30-day period (or portion thereof) within the prescribeddosing period. Prorated copayments for a shorter supply periodmay apply for network pharmacy only. See Prescription Drug section for details. For tiers 1, 2, and 3: Up to a 90-day supply of maintenance and non-maintenance prescription drugs is available at certain network retail pharmacies and a 365-day supply for contraceptive prescription drugs is available at all network pharmacies. A copayment will apply for each 30-day supply. For more information about pharmacies offering this option, visit our website. Tier 1: $10 Not Covered Tier 2: $30 Not Covered Tier 3: $50 Not Covered Tier 4: $75 Not Covered Tier 5: See specialty prescription drug section below. Not Covered When purchased at a Mail Order Pharmacy: Up to a 90-day supply of maintenance and non- maintenance prescription drugs. Tier 1: $25 Not Covered Tier 2: $75 Not Covered Tier 3: $125 Not Covered Tier 4: $225 Not Covered Tier 5: See specialty prescription drug section below. Not Covered

  • How Are Distributions from a Xxxx XXX Taxed for Federal Income Tax Purposes Amounts distributed to you are generally excludable from your gross income if they (i) are paid after you attain age 59½, (ii) are made to your beneficiary after your death, (iii) are attributable to your becoming disabled, (iv) subject to various limits, the distribution is used to purchase a first home or, in limited cases, a second or subsequent home for you, your spouse, or you or your spouse’s grandchild or ancestor, or (v) are rolled over to another Xxxx XXX. Regardless of the foregoing, if you or your beneficiary receives a distribution within the five-taxable-year period starting with the beginning of the year to which your initial contribution to your Xxxx XXX applies, the earnings on your account are includable in taxable income. In addition, if you roll over (convert) funds to your Xxxx XXX from another individual retirement plan (such as a Traditional IRA or another Xxxx XXX into which amounts were rolled from a Traditional IRA), the portion of a distribution attributable to rolled-over amounts which exceeds the amounts taxed in connection with the conversion to a Xxxx XXX is includable in income (and subject to penalty tax) if it is distributed prior to the end of the five-tax-year period beginning with the start of the tax year during which the rollover occurred. An amount taxed in connection with a rollover is subject to a 10% penalty tax if it is distributed before the end of the five-tax-year period. As noted above, the five-year holding period requirement is measured from the beginning of the five-taxable-year period beginning with the first taxable year for which you (or your spouse) made a contribution to a Xxxx XXX on your behalf. Previously, the law required that a separate five-year holding period apply to regular Xxxx XXX contributions and to amounts contributed to a Xxxx XXX as a result of the rollover or conversion of a Traditional IRA. Even though the holding period requirement has been simplified, it may still be advisable to keep regular Xxxx XXX contributions and rollover/ conversion Xxxx XXX contributions in separate accounts. This is because amounts withdrawn from a rollover/conversion Xxxx XXX within five years of the rollover/conversion may be subject to a 10% penalty tax. As noted above, a distribution from a Xxxx XXX that complies with all of the distribution and holding period requirements is excludable from your gross income. If you receive a distribution from a Xxxx XXX that does not comply with these rules, the part of the distribution that constitutes a return of your contributions will not be included in your taxable income, and the portion that represents earnings will be includable in your income. For this purpose, certain ordering rules apply. Amounts distributed to you are treated as coming first from your non-deductible contributions. The next portion of a distribution is treated as coming from amounts which have been rolled over (converted) from any non-Xxxx IRAs in the order such amounts were rolled over. Any remaining amounts (including all earnings) are distributed last. Any portion of your distribution which does not meet the criteria for exclusion from gross income may also be subject to a 10% penalty tax. Note that to the extent a distribution would be taxable to you, neither you nor anyone else can qualify for capital gains treatment for amounts distributed from your account. Similarly, you are not entitled to the special five- or ten- year averaging rule for lump-sum distributions that may be available to persons receiving distributions from certain other types of retirement plans. Rather, the taxable portion of any distribution is taxed to you as ordinary income. Your Xxxx XXX is not subject to taxes on excess distributions or on excess amounts remaining in your account as of your date of death. You must indicate on your distribution request whether federal income taxes should be withheld on a distribution from a Xxxx XXX. If you do not make a withholding election, we will not withhold federal or state income tax. Note that, for federal tax purposes (for example, for purposes of applying the ordering rules described above), Xxxx IRAs are considered separately from Traditional IRAs.

Time is Money Join Law Insider Premium to draft better contracts faster.