Common Contracts
3 similar Stop Loss Application and Administrative Services Agreement contracts
ADMINISTRATIVE SERVICES AGREEMENTStop Loss Application and Administrative Services Agreement • August 30th, 2023
The Plan Sponsor (also referred to herein as the “Applicant”), hereby applies to the Company for a stop loss insurance policy providing the insurance coverage described in the Policy in connection with its self-funded health benefit plan. It is understood and agreed, as conditions precedent to the approval of this Stop Loss Application (this “Application”), that: All documentation requested by the Company must be submitted before any approval of this Application. Issuance of the Stop Loss Policy (the “Policy”) relies on information provided by the Applicant and any person acting on behalf of the Applicant. Accordingly, should subsequent information become known that, if known before issuance of the Policy, would have affected the rates, deductibles, terms, or conditions for coverage, the Company will have the right to revise the rates, deductibles, terms, or conditions as of the Effective Date of issuance, by providing written notice to the Plan Sponsor. The Policy, if issued, may be
ADMINISTRATIVE SERVICES AGREEMENTStop Loss Application and Administrative Services Agreement • December 9th, 2022
The Plan Sponsor (also referred to herein as the “Applicant”), hereby applies to the Company for a stop loss insurancepolicy providing the insurance coverage described in the Policy in connection with its self-funded health benefit plan. It is understood and agreed, as conditions precedent to the approval of this Stop Loss Application (this “Application”), that: All documentation requested by the Company must be submitted before any approval of this Application. Issuance of the Stop Loss Policy (the “Policy”) relies on information provided by the Applicant and any person acting on behalf of the Applicant. Accordingly, should subsequent information become known that, if known before issuance of the Policy, would have affected the rates, deductibles, terms, or conditions for coverage, the Company will have the right to revise the rates, deductibles, terms, or conditions as of the Effective Date of issuance, by providing written notice to the Plan Sponsor. The Policy, if issued, may be
ADMINISTRATIVE SERVICES AGREEMENTStop Loss Application and Administrative Services Agreement • December 8th, 2022
The Plan Sponsor (also referred to herein as the “Applicant”), hereby applies to the Company for a stop loss insurancepolicy providing the insurance coverage described in the Policy in connection with its self-funded health benefit plan. It is understood and agreed, as conditions precedent to the approval of this Stop Loss Application (this “Application”), that: All documentation requested by the Company must be submitted before any approval of this Application. Issuance of the Stop Loss Policy (the “Policy”) relies on information provided by the Applicant and any person acting on behalf of the Applicant. Accordingly, should subsequent information become known that, if known before issuance of the Policy, would have affected the rates, deductibles, terms, or conditions for coverage, the Company will have the right to revise the rates, deductibles, terms, or conditions as of the Effective Date of issuance, by providing written notice to the Plan Sponsor. The Policy, if issued, may be
