Aggregate excess loss coverage is provided to limit the employer’s overall annual liability for a self funded plan. This coverage addresses the accumulation of expenses on individuals (as opposed to high expenses for particular individuals) covered under the plan. When eligible expenses paid during a contract period exceed the annual aggregate deductible, the group is reimbursed as specified in the contract, typically after the close of the contract period.

In addition to medical benefits, most health benefits can be included in the Aggregate coverage with proper underwriting such as Prescription Drug, Dental, Vision and Short-Term Disability. Except for Prescription Drug Coverage, these ancillary charges cannot be included for coverage if they are a first time benefit offering to plan participants. See the “General Claim Handling Information” section of the SLG Benefit’s Claims Guide for more detailed information regarding eligibility of non-standard expenses under the Aggregate.

The premium charged for this coverage is expressed as a rate per covered unit per month or as an amount due annually in advance. New monthly deductible factors, a new Minimum Aggregate Attachment Point and new rates are established at each contract renewal.

The Annual Aggregate Attachment Point is the greater of:

1. the sum of Monthly Aggregate Factor amounts for each month of the Policy Period, determined by multiplying the total number of Covered Units by the Monthly Aggregate Factor amounts or
    

2. the Minimum Annual Aggregate Attachment Point.

The Minimum Annual Aggregate Attachment Point is the lowest amount of total Payments you must make under your Plan before you are eligible for reimbursement under the Aggregate Excess Loss coverage. The Minimum Annual Aggregate Attachment Point is established based on the first months enrollment multiplied by the Monthly Aggregate Factor multiplied by the total number of months and is shown in the Schedule.

The maximum per Covered Person which may be applied annually to the Annual Aggregate Attachment Point (i.e. Individual Claim Limit) is also shown in the Schedule.
 

Aggregate Contract Options Offered

1.  Incurred and Paid (12/12)
   
   Eligible Claims will be covered that are in excess of the group’s Aggregate
   Attachment Point and are:
   1. Incurred during the contract Period, and
   2. Paid during the Contract Period
       
2. Incurred and Paid with a three month run-in provision (15/12)
   
   Eligible Claims will be covered that are in excess of the group’s Aggregate
   Attachment Point and are:
   1. Incurred during the Contract Period, or within three months prior to the
      beginning of the Contract Period, and
   2. Paid during the Contract Period
       
3. Incurred and Paid with a six month run-in provision (18/12)
   
   Eligible Claims will be covered that are in excess of the group’s Aggregate
   Attachment Point and are:
   1. Incurred during the Contract Period, or within six months prior to the
      beginning of the Contract Period, and
   2. Paid during the Contract Period
       
4. Incurred and Paid with a twelve month run-in provision (24/12)
   
   Eligible Claims will be covered that are in excess of the group’s Aggregate
   Attachment Point and are:
   1. Incurred during the Contract Period, or within twelve months prior to the
      beginning of the Contract Period, and
   2. Paid during the Contract Period
       
5. Paid
   
   Eligible Claims will be covered that are in excess of the group’s Aggregate
   Attachment Point and are:
   1. Incurred during the Contract Period, or within 12 months prior to the
      group’s original effective date with SLG Benefits.
   2. Paid during the Contract Period
       
6. Incurred in the Contract Period and Paid in the Contract Period plus three months (12/15)
   
   Eligible Claims will be covered that are in excess of the group’s Aggregate
   Attachment Point and are:
   1. a. Incurred during the Contract Period, and
   2. b. Paid during the Contract Period or within three months thereafter
       
7. Incurred in the Contract Period and Paid in the Contract Period plus six months (12/18)
   
   Eligible Claims will be covered that are in excess of the group’s Aggregate
   Attachment Point and are:
   1. Incurred during the Contract Period, and
   2. Paid during the Contract Period or within six months thereafter
       
8. Incurred in the Contract Period and Paid in the Contract Period plus three months (12/24)
   
   Eligible Claims will be covered that are in excess of the group’s Aggregate
   Attachment Point and are:
   1. Incurred during the Contract Period, and
   2. Paid during the Contract Period or within twelve months thereafter

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