Stop Loss Program definition

Stop Loss Program means the stop loss program implemented and maintained by Health Plan to cover percent of the amounts paid for Referral Services above the applicable identified deductible.
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Stop Loss Program will mean the program through which Physician Group is provided with additional compensation for Capitated Services rendered to an Enrollee, when the value of such services exceeds a specified limit per year per Enrollee.
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Examples of Stop Loss Program in a sentence

  • PPG elects not to participate in the Professional Stop Loss Program.

  • The Professional Stop Loss Program includes coverage for In-Network Services, an optional program, as well as for Out-of-Network Services, a program in which PPG’s participation is required.

  • In the event such audit determines that there has been an underpayment in Stop Loss Program reimbursement, Blue Shield shall pay to Group the amount of such underpayment within forty-five (45) working business days thereafter.

  • In the event such audit determines that there has been an overpayment in Stop Loss Program reimbursement, Group shall pay to Blue Shield the amount of such overpayment within forty-five (45) working business days thereafter.

  • Without limiting the foregoing, Stop Loss Program reimbursement is not paid for any monetary compensation payable to a Member for any reason, including Group’s negligence in providing or arranging or failing to provide services.

  • Medicare Supplement Members shall not be included in the Professional Stop Loss Program, the AIDS Reinsurance Program, and the Transplant Reinsurance Program.

  • For those employees participating in the HMO or Point-of-Service medical plan, the District’s Health Benefits Stop Loss Program shall reimburse the unit member for co-payments in excess of $300 for an individual or $500 for a family in any fiscal year (July 1 - June 30).

  • Commencement of Stop Loss Program: If, as set forth on the Signature Page to the Agreement, Group elects to participate in this Stop Loss Program, this Exhibit H is added to the HMO Medical Agreement (the “Agreement”) between Group and Blue Shield.

  • Notwithstanding any provision of the Agreement or this Exhibit H to the contrary, Blue Shield shall have no obligation to permit Group to commence the Stop Loss Program other than as of the first day of an Agreement Year.

  • Medicare Supplement Members shall not be included in the Professional Stop Loss Program, the AIDS Reinsurance Program or the Transfer Reinsurance Program.

Related to Stop Loss Program

  • Stop Loss expects to close a previously opened position at a quote less profitable for the Client, than the current quote at the moment of an order placement;

  • AML Program has the meaning ascribed thereto in Schedule 2.1(F)(8) hereof.

  • Stop Loss Order means an order placed to close a position once it hits a specific price in order to protect yourself from further losses and avoid potential close-outs/stop-outs.

  • Program means the statutorily authorized activities of the System Agency under which this Contract has been awarded.

  • CRAF Program means the Civil Reserve Air Fleet Program authorized under 10 U.S.C. Section 9511 et seq. or any similar or substitute program under the laws of the United States.