2005-040 - Laserfiche WebLink

Home Browse Search

CLAIMS PROVISIONS (continued ) - LIST OF POTENTIAL LARGE CLAIMS Covered Expenses which qualify as Potential Large Claims are listed below. SAFECO retains the right to add to or delete from the list of Potential Large Claims with 30 days written notice to the Participating Employer. • Transplants , whether incurred or anticipated • Dialysis , home infusion or injection therapy other than insulin or vitamins 0 Cancer • Chemotherapy or radiation • Multiple trauma • Premature birth at less than 34 week gestation • Any inpatient confinement greater than 7 days including acute rehabilitation or skilled nursing • Brain or spinal cord injury or stroke • High risk pregnancy or pre-term labor CASE MANAGEMENT If SAFECO recommends alternative care and treatment that is not provided for in the Employee Benefit Plan and the Participating Employer allows charges for such recommended care and treatment to be considered eligible under the Employee Benefit Plan , these charges will be considered Covered Expenses under this Policy. NOTICE OF EXCESS LOSS CLAIM Aggregate Excess Loss Claim The Participating Employer will give written notice of Aggregate Excess Loss claims to SAFECO within 31 days of the date Covered Expenses have reached the Aggregate Attachment Point . Individual Excess Loss Claim The Participating Employer will give written notice of Individual Excess Loss claims to SAFECO within 31 days of the date the Covered Expenses , with respect to a Covered Unit or Covered Family Unit, have reached the Individual Deductible . The Participating Employer's failure to furnish written notice within 31 days will not invalidate or reduce any claim if it were not reasonably possible to provide written notice within such time . However, written notice must be furnished as soon as possible , but in no event later than 1 year after the date written notice is first required . The Participating Employer or the Participating Employer's Claims Administrator(s) will submit on a timely basis all proofs of loss , reports , and supporting documents that SAFECO may request. LGC 8815 03/02 2