R2010-233 AUTHORIZING AGREEMENT - Laserfiche WebLink

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� � includes CPaim Administrator's Provider Access Fee � ❑ Excludes Claim Administrator's Provider Access Fee Attachment Factor: 125% of the Average Claim Value 5. Aggregate Attachment Claim Liability: Employer's Claim Liability for each Policy Period shall be the sum of the Monthly amounts obtained by multiplying the number of Individual and Family Coverage Units for each Month by the following factor: $1,162.13for each Coverage Unit 6. Aggregate Stop Loss Coverage includes coverage of Run-Off Paid Claims: �Yes ❑ No Run-Off Attachment Claim Liability Factors: Employer's Run-Off Claim Liability shall be an amount equal to 15%of the annualized Employer Claim Liability i based on the participation of the two calendar months immediately preceding termination. Settlement for the I final accounting period will be described in the section of the Policy entitled SETTLEMENTS. '� 7. Aggregate Stop Loss Coverage: a. The amount of Paid Claims during the current Policy Period, less Individual (Specific) Stop Loss Claims, if any, that exceed the Point of Attachment. The Point of Attachment shall equal the sum of the Employer's Claim Liability amounts calculated Monthly as described in Item 5. above for the indicated Policy Period. However, for the indicated Policy Period the minimum Point of Attachment shall be$8,170,667. b. The following applies if the answer to item 6. above is"Yes-" (Aggregate Stop Loss Coverage includes coverage of Run-Off Paid Claims): In the event of termination at the end of a Policy Period, Aggregate Stop Loss Coverage shall equal the amount of Final Settlement Paid Claims that exceed the Final Settlement Point of Attachment. Final Settlement Paid Claims shall equal the sum of the Paid Claims during the Final Policy Period and the Paid Claims during the Run-Off Period, less Individuat (Specific) Stop Loss Claims, if any. The Final Settlement Point of Attachment shall equal the sum of the Employer's Claim Liability amount for the Final Policy Period and the Employer's Run-Off Claim Liability calculated as described in items 5. and 6. above. However, for the Final Settlement Period the minimum Point of Attachment shall be the minimum Point of Attachment in item 7.a. above increased by 15%. 8. Premium (Select one): � Annual Premium (Due on the first day of the Policy Period): $70,449. The following applies if the answer to item 6. above is"Yes.-" (Aggregate Stop Loss Coverage includes coverage of Run-Off Paid Claims): In the event of termination at the end of a Policy Period, an additional premium amount equal to 15% of the Annual Premium will be due within 10 calendar days of receipt of the billing. ❑ Monthly Premium shall be equal to the amounts obtained by multiplying the number of Individual and Family Coverage Units for a particular Month by: $ for each Coverage Unit The following applies if the answer to item 6. above is"Yes-" (Aggregate Stop Loss Coverage includes coverage of Run-Off Paid Claims): In the event of termination at the end of a Policy Period, an additional premium amount equal to 15% of the annualized Premium based on the participation of the two months immediately preceding termination will be due within 10 calendar days of receipt of the billing. 9. The premium is based upon a current membership of 248 Individual Coverage Units and 403 Family Coverage Units. B. Individual (Specific) Stop Loss Insurance: � Yes ❑ No If yes, complete items 1. through 6. below. 1. ❑ New Coverage � Renewal of Existing Coverage GA-10-4.1 HCSC Rev.4/07