Insurance Plan Retrospective Premium Agreement Sample Contracts

The Arizona Board of Regents
Insurance Plan Retrospective Premium Agreement • May 3rd, 2021

This Letter of Agreement (the “Agreement”), effective as of August 16, 2021, serves to document our mutual understanding and agreement of the circumstances under which The Arizona Board of Regents, on behalf of Arizona State University (Policy #697443), Northern Arizona University (Policy #697444), and University of Arizona (Policy #697442) on a combined basis, would be entitled to return of potential premium surplus, based on claims experience, under the Blanket Student Accident and Sickness Insurance Policy (the “Policy”) between The Arizona Board of Regents (the “Policyholder”) and Aetna Life Insurance Company (the “Company”). Capitalized terms not otherwise defined herein shall have the meaning given to them in the Policy. This agreement covers only the Student Accident and Sickness plan. Such arrangements are subject to state and federal insurance requirements, and Aetna has the right to revoke this Agreement if insurance regulators disallow them.

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