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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 $37,500.

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.