Spaggregrate™ Claims Reporting
The following are the procedures for claim reporting that TPAC Underwriters is expecting on Spaggregate cases. We are asking that you provide a report on every Spaggregate group, at renewal and/or as soon as a claimant is diagnosed, regarding claimants that have been continuously hospitalized more than 10 consecutive days, had multiple admissions totaling 15 days or more or have been diagnosed with:
- AIDS, AIDS-related disease, HIV
- Birth of premature child or children or those children born with abnormalities
- Brain Injury or trauma to the head
- Burns, second degree or higher
- Cancer, leukemia, Hodgkins, lupus or lymphoma
- End Stage Renal Disease
- Internal injuries, crushing or massive
- Organ Transplants including Bone Marrow and Stem Cell
- Pregnancy identified as high-risk or expectation of multiple births
- Spinal injury resulting in real or suspected paralysis
- Stroke
And all claims (pended or paid) regardless of the diagnosis that exceed:
- $15,000 on a group of 100 lives or less
- $25,000 on a group of 101 lives to 500 lives
- $50,000 on a group of 500+ lives
We will need this report on a monthly basis along with a total paid claims report in a similar format to the way aggregate reports are now sent. Simply show total monthly paid claims versus monthly funding factors.