Large Claims. As a condition of reinsurance and prior to commencing any loss adjustment activity, the Company agrees to comply with all provisions of FCIC’s Large Claims Procedures, as applicable.
Large Claims. Claims for each insured member over an agreed upon amount determined by the ECHMC in consultation with their broker. • Stop Loss o The maximum amount of claims paid by the ECHMC for any individual insured claim in a single year. All claim expenses over this amount are covered by the carrier. This amount is negotiated with the carrier on an annual basis. In addition, a maximum aggregate amount is set by the carrier on an annual basis for all claims for the entire ECHMC. Once this aggregate amount is reached all claims are covered by the carrier. • Operating Revenues o This is the premiums paid into the plan by each member of the ECHMC including employee and employer contributions. • Operating Expenses o The medical and dental claims (expenses) paid by each member of the ECHMC. • Fiscal Agent o The entity contracted by the ECHMC to provide financial services including, but not limited to, financial statement preparation, collection of all premiums, reconciliation of all claim activity, wiring of money to/from bank(s), bank reconciliations, tallying census activity for each group, and email correspondence to member districts/towns. • Surplus / (Deficit) o Premiums collected less claims paid • Claims Payable - Incurred But Not Reported (IBNR)
Large Claims. As a condition of reinsurance and prior to commencing any loss adjustment activity, the Company agrees to comply with all provisions of FCIC’s Large Claims Procedures, as applicable. As a condition of reinsurance, prior to commencing any loss adjustment activities, the Company must notify FCIC upon receiving notice of a potential claim on an eligible crop insurance contract that is likely to exceed $500,000, or such other amount as determined by FCIC.
