GENERAL POLICY ADMINISTRATION
SLG Benefits' Policy
Administration function is integrated with each producer’s
underwriting team. Applications for coverage will be initiated upon
notification to your underwriter that the group has accepted our stop
loss proposal. The Application and Schedule of Insurance, once
reviewed and completed to the producer’s satisfaction, must be signed
by the employer and then returned to your underwriter along with all
other required documents. These documents will initiate coverage and
become part of the employer group’s Excess Loss Insurance Policy.
It is important to
note that the policies and procedures outlined in this section are
meant to be used as a guide and are stated in general terms. The
specific terms and conditions found in the Policyholder’s Application,
Schedule of Insurance and Policy shall be considered the binding
terms. Please contact your SLG underwriter at any time with questions
or to request a specimen Policy and/or sample application. A careful
review of these documents should help prevent any misunderstandings
between the Plan Sponsor and insurance carrier as to the nature of
coverage in effect during the Policy Period.
DOCUMENTS INITIATING
COVERAGE
When the SLG
Underwriter is informed that a client has accepted our proposal we
will prepare a formal Application and Schedule of Insurance for
presentation to the client. The Application contains important terms
of the Policy being offered and applied for, tentative rates and
coverage levels and the information necessary to complete final
underwriting. The information included in the Application is used to
complete the Schedule of Insurance.
The Application,
Schedule of Insurance and Disclosure Statement must be signed and
returned to SLG Benefits within 15 days after the effective date along
with binder premium and corresponding Premium and Enrollment
Statement. We cannot complete final underwriting or issue the Policy
unless all outstanding items are received in a timely manner. We
cannot release claim payments until a Policy has been issued. In
addition, we cannot release commissions to the producer until the
Policy has been issued and the Agent of Record has provided all
necessary licensing information to SLG Benefits and is appointed by
the insurance carrier.
To follow please find
a brief description of the key documents necessary to bind coverage
and fully issue the Excess Loss Insurance Policy:
APPLICATION
SLG Benefits will
prepare this form and send it to the Producer for presentation to the
client. The Application must be signed by a duly authorized official
of the Plan Sponsor, as well as by the licensed agent. It is then
returned to SLG Benefits. All information should be reviewed carefully
and completed on the Application and signed by all appropriate parties
prior to returning the document to SLG Benefits. We request that you
carefully review the provisions for each type of coverage offered with
the client. Be sure that they specifically understand which benefits
are included in the Aggregate coverage. Typically, Medical and
Prescription Drug benefits are included under the Aggregate coverage.
It is also important that you explain the maximums, limits, rate,
factors, excess loss coverage basis (Paid, Incurred and Paid, etc.)
and the function of the Aggregate Deductible.
Please find a more detailed
description of some of the key Application items below:
Specific Lifetime Maximum
Reimbursement per Covered Person:
Unless otherwise
specified, this amount is $1,000,000 less the Specific Attachment
Point amount. The Lifetime Maximum will not exceed the lesser of (1)
the amount shown in the Schedule; or (2) the lifetime amount set
forth in the Plan.
Specific Reimbursement Percentage:
Unless otherwise specified, 100%
Maximum Aggregate Reimbursement
(per Policy Period):
Unless otherwise specified, this
amount is typically $1,000,000
Aggregate Reimbursement
Percentage:
Unless otherwise specified, 100%
Individual Claim Limit (Aggregate
Loss Limit):
The maximum amount
of Payments for Eligible Expenses counted for any one Covered Person
under the Aggregate Excess Loss coverage (Typically equal to the
Specific Attachment Point).
Please do not
modify any coverage descriptions, factors, rates or limits without
first calling SLG Benefits to see if a new application needs to be
prepared. If a new application is necessary, SLG Benefits will
promptly supply a revised copy.
The Application must
be signed by an officer of the Plan Sponsor and clearly show the name
and title of the person signing. This is the client contact SLG
Benefits will use, if necessary, to communicate with during the Policy
Period.
Finally, the
Application must be signed (witnessed) by the Licensed Agent
representing the Plan Sponsor and appointed by the insurance carrier.
Please contact your
underwriter for assistance or questions regarding the completion of
the Application.
A sample Application can be found in
the Forms Section of this Guide.
SCHEDULE OF INSURANCE
The Schedule of
Insurance is completed using the information detailed in the
Application. SLG practices a paperwork reduction policy. This means
your SLG underwriter will typically gather more information in an
attempt to send out a Schedule of Insurance that is correct the first
time. In doing this, we feel it makes sound business sense to issue
the Schedule of Insurance along with the Application so our producers
need not make multiple trips to the Policyholder delivering singular
documents for signature.
Please do not
modify any coverage descriptions, factors, rates or limits without
first calling SLG Benefits to see if a new Schedule of Insurance needs
to be prepared. If a new Schedule of Insurance is necessary, SLG
Benefits will promptly supply a revised copy.
The Schedule of
Insurance must be signed by an officer of the Plan Sponsor and clearly
show the name and title of the person signing. This is the client
contact SLG Benefits will use, if necessary, to communicate with
during the Policy Period.
Finally, the Schedule
of Insurance must be signed (witnessed) by the Licensed Agent
representing the Plan Sponsor and appointed by the insurance carrier.
A sample Schedule of Insurance can be
found in the
Forms Section of this Guide.
DISCLOSURE
STATEMENT
A Plan Sponsor
Disclosure Statement must be completed for all new business accounts
with SLG, even if the group is currently with the producer. It’s
purpose is to provide your underwriter with a complete list of plan
participants, including employees, dependents, retirees and COBRA
beneficiaries who are not at work or "at life" due to illness or
injury on the proposed effective date or who incurred (or have the
potential to incur) charges in excess of $10,000 (or 50% of the
Specific Deductible) in the last twelve months. This statement should
be completed and submitted to us within the 15 day period immediately
prior to the effective date. The Disclosure Statement is issued with
detailed instructions to assist in completion by the Plan Sponsor.
However, if there are any questions, please contact your underwriter
immediately for assistance with this important document.
PREMIUM AND
ENROLLMENT STATEMENT
All premium payments should be made
payable to SLG Benefits and Insurance, LLC and sent to:
SLG Benefits and Insurance, LLC
9 Atlantic Avenue
Marblehead, MA 01945
The deposit premium
is referenced on the Application and should be equal to the first
month's Specific and Aggregate Premium (or the estimated annual
Aggregate Premium amount, if being paid annually). The premium will be
deposited in an escrow account until final underwriting is completed
and coverage is bound.
MASTER PLAN
DOCUMENT
The Master Plan
Document forms an important part of the Excess Loss Insurance Policy.
We require a fully executed copy signed by an official of the Plan
Sponsor. The Plan Sponsor's signature on the copy forwarded to SLG
Benefits acknowledges that Eligible Expenses will be reimbursed within
the provisions of the plan document in our possession. This document
will be used by SLG Benefits when reviewing specific and aggregate
claims submitted for reimbursement under the Excess Loss Insurance
Policy. SLG Benefits will review and verify that the plan document
benefits match those understood by your SLG Benefits Underwriter at
the time the proposal was prepared. Any changes from the originally
submitted benefit plan quoted by the underwriter must be approved
prior to acceptance and issuance of the Policy. Furthermore, all
amendments considered during the Plan Year must be submitted to SLG
Benefits for review prior to acceptance under the Excess Loss
Insurance Policy.
Please be aware that
SLG Benefits and Insurance, LLC, on behalf of our insurance company
partners, is prohibited from considering any claim for
reimbursement without receipt and acceptance of the signed Master Plan
Document.
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