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Aggregate Accommodation Claims

for Traditional Products

  1. WHAT IS AN AGGREGATE ACCOMMODATION CLAIM?
    • This is when an Employer Group pays eligible Claims for covered person in excess of the Cumulative Monthly Aggregate Point. This requires a signed Amendment to be included in the Excess Loss Policy.
  2. SUBMISSION OF AN AGGREGATE ACCOMMODATION CLAIM.
    • If the Employer pays Plan Benefits that exceed the Cumulative Monthly Aggregate Deductible less the $3,000 Monthly Aggregate Deductible, the Company will pay the Employer the lesser of:
      • The amount by which such paid claims exceed the Cumulative Monthly Aggregate Deductible less the $3,000 Monthly Aggregate Deductible; or
      • The amount by which such paid claims exceed the pro-rated Minimum Annual Aggregate Deductible less the $3,000 Monthly Aggregate Deductible as explained under the section How Do I calculate an Aggregate Accommodation Claim.
    • The administrator should forward the following information:
      • Completed Monthly Aggregate Excess Loss Report for the policy year. This is a cumulative report that is completed each month. The report must show employee counts (single & family coverages).
      • Complete Aggregate Accommodation Reimbursement Claim Form signed and dated by the administrator.
      • A Claim Report showing the name of claimant and/or dependent, incurred date of each loss, date of payment, amount of each payment, amount of charge and the payee.
      • A list of all Specific Stop Loss claims for the Aggregate policy year under consideration. Such listing should indicate whether or not these claims have been submitted to TPAC Underwriters, Inc. for consideration and if not submitted, an explanation should be provided.
      • A complete listing of claims paid outside of the Aggregate.
      • A complete listing of all voids/refunds.
    • The claim should be submitted as soon as possible after the end of the month. Requests cannot be made for the twelfth month (or last month of the contract).
    • All premium due under the policy have been paid.
  3. REPAYMENT OF THE AGGREGATE ACCOMMODATION CLAIM.
    • Please see the Aggregate Accommodation Benefit Amendment for details regarding repayment of Aggregate Accommodation Claims.