My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
2018-171
CBCC
>
Official Documents
>
2010's
>
2018
>
2018-171
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
1/4/2021 11:22:18 AM
Creation date
9/19/2018 1:49:56 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Proposal
Approved Date
09/11/2018
Control Number
2018-171
Agenda Item Number
8.BB.
Entity Name
Blue Cross and Blue Shield
Florida Blue
Subject
Excess Loss/Reinsurance Policy
stop loss policy
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
6
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
Florin B&M 0 d <br />An Independent Licensee of the <br />Blue Cross and Blue Shield Association <br />STOP LOSS PROPOSAL FOR <br />Indian River County Board of County Comm <br />• The rates and factors in this proposal are based on the disclosure of all individuals considered a special enrollee due to having previously satisfied <br />the plan's lifetime maximum. Written acceptance by Florida Blue must be acknowledged before terms of coverage for such individuals are <br />included under Florida Blue's stop loss policy. <br />• Any stop loss policy issued by us may be rescinded or re -underwritten if any information requested in connection with this proposal was <br />intentionally concealed or misrepresented by or on behalf of the Applicant and/or the Applicant's Agent, or if the Applicant and/or the Applicant's <br />Agent commits fraud. <br />• As used above: An "Agent" is the Applicant's representative, including but not limited to, the agent, producer or broker of record, or Claims <br />Administrator. The "Applicant" is the entity, or that entity's authorized representative, that has contracted with us to provide stop loss coverage. A <br />"Claims Administrator" is a third party administrator (TPA) designated by the Applicant and approved by us. "Claim Information" consists of <br />Complete Details of the data requested by us in connection with this proposal following a Diligent Review; such information includes but is not <br />limited to Know or potential catastrophic claims, large claims and/or shock losses. "Complete Details" includes the name, social security number <br />(or unique identifier), date of birth, diagnosis, prognosis (unless prognosis cannot be obtained due to reasons beyond your or your Claims <br />Administrator's control) of the plan's participants and the name of the provider providing treatment to any such participant covered by or eligible for <br />coverage. A "Diligent Review" consists of a complete review by you, and/or your Claims Administrator and/or your Agent prior to the date Known <br />or potential catastrophic claims, large claims and/or shock losses are requested by us in connection with this proposal. "Disclosure" consists of <br />Complete Details and any other documentation requested by us in connection with this proposal following a Diligent Review including but not <br />limited to census information and Claim Information. We consider information in connection with this proposal "Known" if, prior to the date or <br />dates we request such information (including but not limited to Disclosure and Claim Information) a reasonable person can assume that you, <br />and/or your Claims Administrator and/or your Agent had knowledge of any information that affects or may affect the administration or underwriting <br />of any coverage issued following acceptance of coverage by us. <br />Coverage is underwritten by Florida Blue, Jacksonville. FL and is administered by HM Life Insurance Company, Pittsburgh. PA. HM Life Insurance <br />Company is an independent company providing only administrative services. <br />Underwriter: REB (August 30, 2018) 10554202426-2018-546579-2-2 Page 6 of 6 <br />
The URL can be used to link to this page
Your browser does not support the video tag.