IBNR Claims definition

IBNR Claims. As defined in Section 13.11.

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IBNR Claims means Claims which are incurred during the term of this Contract, including during the Transition Assistance Period, but have not been reported to the Group as Amounts Billed or paid and which remain the Group's liability.

IBNR Claims shall refer to claims for services provided to Members which are the financial responsibility of Medical Group, and which have been incurred, but which have not been reported to Medical Group.

Examples of IBNR Claims in a sentence

• Sellers shall promptly provide Purchaser with (i) copies of such plan amendments and the general form of communications to participants and beneficiaries, together with information regarding the date and manner of communication, and (ii) reasonably detailed claims information as such information becomes available during the IBNR Claims Period so that Purchaser has an opportunity to review such information.

• The reserves for "incurred but not reported" claims ("IBNR Claims") reflected on the Company Financial Statements for the fiscal year ended December 31, 1996 and the month ended immediately preceding the Closing Date are and will be adequate and sufficient, and were determined in accordance with the Company's customary internal accounting practices with respect to reserves for IBNR Claims.

• To effect the IBNR Reconciliation, the parties shall compare the amount of the IBNR reserve that was set forth on the Closing Date Balance Sheet (“IBNR Closing Date Reserve Amount”) to the IBNR Claims.

• IBNR Claims shall include all claims for which a specific claim reserve was not held on the Effective Date.

• Conversely, if the IBNR Claims are $4,400,000, then the Group IBNR Reimbursement Amount owed by Group by means of a credit to the Indemnification Escrow Amount would be $100,000 ($4,500,000 - $4,400,000).

• On the other hand, if the IBNR Claims were less than the amount of the Closing Date Reserve Amount less an additional 10% below such IBNR Closing Date Reserve Amount (“Upward IBNR Reconciliation Threshold Amount”) (such difference constituting the “Group IBNR Reimbursement Amount), Group shall be required to immediately reimburse the ProMed Upland Shareholder the dollar amount of the Group Reimbursement Amount.

• The Escrow Agent will cause to be paid to the Company the amounts necessary to satisfy all Eligible IBNR Claims payable prior to the end of the IBNR Escrow Period, up to the aggregate amount of the IBNR Escrow Deposit.

• Conversely, if the IBNR Claims are $800,000, then the Prospect IBNR Reimbursement Amount owed by the Heritage Parties to the Prospect Parties would be $150,000 ($950,000 - $800,000).

• The Heritage Parties, as owners of the AV Entities after the Closing Date, shall, for the period commencing on the Closing Date and ending not earlier than eighteen (18) months thereafter, keep an account of claims received on or after the Closing Date for dates of service prior to the Closing Date and either paid from, or to be paid from, IBNR funds ("IBNR Claims").

• If the IBNR Claims are $1,200,000, then the Heritage IBNR Reimbursement Amount that would be owed by the Prospect Parties would total $150,000 ($1,200,000 - $1,050,000).

More Definitions of IBNR Claims

IBNR Claims means all incurred but not reported Claims relating to the Debtors' self-funded medical plan, vision plan, or dental plan (collectively, the "Self-Funded Health Plan(s)"), to the extent (a) the services giving rise to such IBNR Claims were performed (i) on or after the commencement of these Chapter 11 Cases and (ii) before the Plan Effective Date, and (b) such IBNR Claims were timely filed under the terms of the applicable Self-Funded Health Plan.

IBNR Claims means Enrollees' claims which are incurred pursuant to this Contract but have not been reported as paid to the State and for which Amounts Billed will remain the State's responsibility pursuant to this Contract.

IBNR Claims means Member’s HRA Claims which are incurred pursuant to this Contract but have not been reported as paid to the Group and for which HRA Claims will remain the Group's responsibility pursuant to this Contract.

IBNR Claims has the meaning set forth in Section 4.5(k).

IBNR Claims. Incurred but not reported Provider claims liability of the Company for Covered Services furnished on or before the Final Balance Sheet Date to Members for which no invoice or billing has been received by the Company or its processing agent on or before the Final Balance Sheet Date; provided that (i) with respect to these incurred but not reported claims payable to Providers who or which have a written agreement with the Company, or one of the Company's other Providers, such claims are (a) adjudicated in an amount determined in accordance with such written agreement and (b) presented for payment to the Company or its processing agent during the Incurred Claims Run-Out Period, and (ii) with respect to incurred but not reported claims payable to Providers who or which do not have such a written agreement, such claims are presented for payment to the Company or its processing agent prior to the expiration of the Incurred Claims Run-Out Period.

IBNR Claims. Incurred but not reported Provider claims liability of the Company for covered treatment or services furnished on or before the Final Balance Sheet Date to Members of the Company's Health Benefit Plans and for which no invoice has been received by the Company or its processing agent on or before the Final Balance Sheet Date; provided that (i) with respect to incurred but not reported claims payable to Providers who or which have a written agreement with the applicable Company, or one of the Company's other Providers, such claims are (a) adjudicated in an amount determined in accordance with such written agreement and (b) presented for payment to the Company or its processing agent during the IBNR Run-Out Period, and (ii) with respect to incurred but not reported claims payable to Providers who or which do not have such a written agreement, such claims are presented for payment to the Company or its processing agent prior to the expiration of the IBNR Run-Out Period.