Claims Payment. The Reinsurer will be liable to the Company for its share of the benefits owed under the express contractual terms of the Reinsured Policies and as specified under the terms of this Agreement. The Reinsurer will not participate in any ex gratia payments made by the Company (i.e., payments the Company is not required to make under the Reinsured Policy terms.) The payment of death benefits by the Reinsurer will be in one lump sum regardless of the mode of settlement under the Reinsured Policy. Benefit payments from the Reinsurer will be due within 30 days of the claim satisfying the requirements established under this Agreement. The Reinsurer’s share of any interest payable under the terms of a Reinsured Policy or applicable law which is based on the death benefits paid by the Company, will be payable provided that the Reinsurer will not be liable for interest accruing on or after the date of the Company’s payment of benefits. The Reinsurer will make payment to the Company for each such claim. For claims on Accelerated Benefit riders reinsured under this Agreement, the benefit amount payable by the Reinsurer will be calculated by multiplying the total accelerated death benefit rider payout by the ratio of the reinsured Net Amount at Risk, as defined in Exhibit C-1, to the face amount of the Reinsured Policy. 196474US-08 ml 20070727 (ODB#I02020US-08) 12
Claims Payment. The Reinsurer will be liable to the Company for the benefits reinsured and the reinsurance will not exceed the Company's contractual liability under the terms of its policies. The payment of death claims by the Reinsurer will be in one lump sum regardless of the mode of settlement under the original policy. The Reinsurer's share of interest, which is based on the death proceeds paid by the Company, will be payable in addition to the death claim settlement. The Reinsurer will pay to the Company premiums at the rate applicable to the original policy on any policy approved for a waiver of premium claim, provided always that the waiver of premium benefit applicable to such benefits has been reinsured under this Agreement.
Claims Payment. If HEBP determines that a claim for benefits is a Valid Claim, or if Plan Administrator directs HEBP, in writing, to honor a claim for benefits, HEBP will arrange for the payment of the claim pursuant to the terms of this Agreement and Addendum A: Transfer Payment and Other Financial Responsibilities.
Claims Payment. All Contract claims services, with the exception of the adjudication of death claims not paid out as a lump sum, shall be performed by LMG on behalf of IIC. Notwithstanding, all such claims in the amount of $100,000 or greater shall be forwarded to IIC for review and approval prior to LMG's payment of the claim. All Contract claims shall be investigated, processed, and paid in accordance with the policies and procedures mutually agreed to by both parties. IIC will make its claims personnel and legal department available at IIC's expense to answer any questions that might arise from LMG's claims personnel relating to claims investigation, processing, and payment of Contract claims. In addition to the foregoing, in the case of a decision by LMG that a Contract claim should be denied, LMG shall communicate its proposed action to appropriate IIC personnel who must agree and approve the proposed claim denial before the claims decision is communicated to the policyholder or beneficiary. LMG will communicate appropriate details of any proposed claim denial in accordance with notification procedures to be jointly developed by the parties, which shall be in sufficient time to allow for a response by IIC and discussion with LMG to avoid violation of laws with respect to claims practices. If no response is received within five (5) business days of transmission, LMG shall have the right to proceed on the basis that IIC is in agreement with the decision to deny the claim. All claims paid by LMG from funds collected on behalf of, or for, IIC shall be paid only on drafts or checks of, and as authorized by, IIC. All monies received by LMG to pay claims on behalf of IIC shall be held in a fiduciary capacity. No deposits will be made into, nor disbursements made from, this fiduciary account, with the exception of claims and claims adjustment expenses. This fiduciary account will at all times have a balance equal to the amount deposited less claims and claims adjustment expenses paid. LMG is responsible for all correspondence with the claimant and preparation of the claim checks. Notwithstanding the foregoing, IIC shall provide legal support to LMG. For those claims referred to IIC by LMG, LMG will provide IIC with copies of the following:
Claims Payment a. Claims that are subject to payment under this Contract by Contractor from Non-Participating Providers who are enrolled with OHA will be billed to Contractor consistent with the requirements of OAR 410-120-1280, 410-120-1295 and 410-120-1300. Contractor shall pay Non-Participating Providers for Covered Services, consistent with the provisions of ORS 414.743, OAR 410-120-1340 and OAR 410-141-3420.
Claims Payment. Consistent with C.4.6(2)of its proposal, the Contractor shall develop and implement a system for processing and paying covered health claims on behalf of the high risk pool program.
Claims Payment a. Claims made in respect of You shall be subject to the availability of the Limit of Liability for the Covered Asset and in the aggregate for this Policy, and applicable Co-payment, and Deductibles specified in the Schedule against the Insuring Clause(s).
Claims Payment. The Reinsurer will be liable to the Company for its share of the benefits owed under the express contractual terms of the Reinsured Policies and as specified under the terms of this Agreement. The Reinsurer will not participate in any ex gratia payments made by the Company (i.e., payments the Company is not required to make under the Reinsured Policy terms.) The payment of death benefits by the Reinsurer will be in one lump sum regardless of the mode of settlement under the Reinsured Policy. Benefit payments from the Reinsurer will be due within 30 days of the claim satisfying the requirements established under this Agreement. The Reinsurer’s share of any interest payable under the terms of a Reinsured Policy or applicable law which is based on the death benefits paid by the Company, will be payable provided that the Reinsurer will not be liable for interest accruing on or after the date of the Company’s payment of benefits. The Reinsurer’s share will be based upon the same interest rate and days used by the Company to calculate their interest paid. The Reinsurer will make payment to the Company for each such claim. I486326US-14 (02-21-2014) (QT #06655US13)
Claims Payment i. We shall be under no obligation to make any payment under this Policy unless We have received all premium payments in full and on time in respect of the Insured Person’s cover under the In-built Benefit and all applicable Cover Benefits and all payments have been realised.
Claims Payment. If Contractor fails to pay or deny ninety-eight per cent (98%) or more of any type of clean claims within the required timeframe, Contractor shall pay liquidated damages in the amount of five thousand, seven hundred dollars ($5,700) for each deficient claims type. For the purposes of this section, there are six claims types: professional paper claims, professional electronic claims, facility paper claims, facility electronic claims, pharmacy paper claims, and pharmacy electronic claims.
