Professional Stop Loss Program Clause Samples
The Professional Stop Loss Program clause establishes a mechanism for limiting the financial exposure of a party, typically an insurer or employer, by capping the amount they are responsible for in the event of high-cost claims. This clause usually applies to health insurance or reinsurance agreements, where it sets a specific threshold; once claims exceed this threshold, the stop loss coverage activates and the excess costs are covered by the stop loss provider. Its core function is to protect organizations from catastrophic losses, ensuring financial stability and predictability by transferring the risk of unusually large claims.
Professional Stop Loss Program. PPG elects not to participate in the Professional Stop Loss Program. PPG shall provide HMO with proof of Professional Stop Loss coverage.
Professional Stop Loss Program. The Professional Stop Loss Program includes coverage for In-Network Services, an optional program, as well as for Out-of-Network Services, a program in which PPG’s participation is required.
(a) In-Network Professional Stop Loss. PPG elects not to participate in the Professional Stop Loss Program. PPG shall provide HMO with proof of Professional Stop Loss coverage.
(b) Out-of-Network Professional Stop Loss. PPG’s Out-of-Network Professional Stop Loss threshold shall be *** per Commercial POS Member during the calendar year. The cost to PPG for the Out-of-Network Professional Stop Loss program shall be *** PMPM, which, shall be deducted from PPG’s Out-of-Network Risk Sharing Budget.
Professional Stop Loss Program. (a) In-Network Professional Stop Loss. PPG elects not to participate in the Professional Stop Loss Program. PPG shall provide HMO with proof of Professional Stop Loss coverage.
(b) Out-of-Network Professional Stop Loss, PPG’s Out-of-Network Professional Stop Loss threshold shall be *** per Medicare POS Member during the calendar year. The cost to PPG for the Out-of-Network Professional Stop Loss program shall be *** of applicable Medicare POS Member’s MCFA payment and county premium, if any, which shall be deducted from PPG’s Out-of-Network Risk Sharing Fund.
Professional Stop Loss Program. The Professional Stop Loss Program includes coverage for In-Network Services, an optional program, as well as for Out-of-Network Services, a program in which PPG’s participation is required.
Professional Stop Loss Program. (a) In-Network Professional Stop Loss. PPG elects not to participate in the Professional Stop Loss Program. PPG shall provide HMO with proof of Professional Stop Loss coverage.
(b) Out-of-Network Professional Stop Loss. PPG’s Out-of-Network Professional Stop Loss threshold shall be *** per Medicare POS Member during the calendar year. The cost to PPG for the Out-of-Network Professional Stop Loss program shall be eighteen one-hundredths percent (0.18 %) of applicable Medicare POS Member’s HCFA payment and county premium, if any, which shall be deducted from PPG’s Out-of-Network Risk Sharing Fund.
Professional Stop Loss Program. (a) In-Network Professional Stop Loss. PPG elects not to participate in the Professional Stop Loss Program. PPG shall provide HMO with proof of Professional Stop Loss coverage.
(b) Out-of-Network Professional Stop Loss. PPG’s Out-of-Network Professional Stop Loss threshold shall be $ 10,000 per Medicare POS Member during the calendar year. The cost to PPG for the Out-of-Network Professional Stop Loss program shall be *** of applicable Medicare POS Member’s HCFA payment and county premium, if any, which shall be deducted from PPG’s Out-of-Network Risk Sharing Fund. Effective January 1, 2001, Out-of-Network Professional Stop Loss. PPG’s Out-of-Network Professional Stop Loss threshold shall be *** per Medicare POS Member during the calendar year. The cost to PPG for the Out-of-Network Professional Stop Loss program shall be 2.03% of applicable Medicare POS Member’s HCFA payment and county premium, if any, which shall be deducted from PPG’s Out-of-Network Risk Sharing Fund.