AGGREGATE ACCOMMODATION OPTION

Aggregate Accommodation is offered as an option to our smaller group clients to provide greater cash flow and financial protection for the largest dollar segment of their health plan. Any Accommodation is at all times, to be considered funds of the Carrier for which the use by the Policyholder of such funds is provided by Endorsement to the Policy. The Aggregate Accommodation should not be construed as a loan or cash advance.

If in any month during the Policy Period, the total Plan Benefits Paid by the Policyholder, for which reimbursement is provided under the Policy, exceeds the sum of:

1. the greater of (a) the accumulated Annual Aggregate Attachment Point or (b) the pro rata of the portion of the Minimum Annual Aggregate Attachment Point; and

2. any previous advances; and

3. $1000;

Then the Policyholder may request an advance of the aggregate excess benefit.
 

Accommodation Filing Requirements

In order to file an Aggregate Accommodation request we require the submission of the following documentation:

1. Completed Aggregate Accommodation Form

2. Monthly Loss Summary Reports showing the Policyholder's monthly paid claims data and aggregate census information

3. Paid Claims Analysis Report showing claimant name, date of service, type of service, amount charged, and amount, date and Payee for each Payment made
    

Accommodation Filing Procedures

• All claims must be Paid by the Plan Sponsor prior to applying for an Aggregate Accommodation.
   

• Aggregate Accommodation requests must be received by SLG Benefits within 20 days following the end of the month for which the accommodation is requested. (For example, if you are filing for the month of July, then we must receive your request no later than August 20th.)
   

• Aggregate Accommodation must be greater than our service minimum requirement of $1,000.
   

• Aggregate Accommodation is not available in the final month of the Policy or during a run-out provision.
   

• The initial request for Aggregate Accommodation cannot be made prior to the end of
  the 90 day period following the first day of the Policy Period.
   

Reconciliation Procedures

If the Policyholder has not incurred an aggregate claim at the end of the Policy year, then the Policyholder must refund all Aggregate Accommodations. If the year-to-date claims fall below the accumulated aggregate deductible in any given month, all Accommodation advances must be refunded in the following month.

Failure to repay any overpayment within 60 days after written notice is provided shall result in either a 10% penalty per annum or a reduction of subsequent reimbursements under the Aggregate or Specific Excess Loss benefits by the amount of the overpayment.

SLG Benefits reserves the right to audit all records affecting our liability under this Policy.

A sample Aggregate Accommodation Form can be found in the Forms Section of this Guide.