Laserfiche WebLink
<br />2 <br /> <br />A stop loss policy for the terms and conditions noted herein, subject to receipt and carrier approval of <br />the following documentation. will be issued by American National Insurance to the City of San Marcos: <br /> <br />· Final plan document including any proposed plan changes effective August 1. 1999. (Due within <br />60 days after the effective date). <br />· Current census that lists all covered employees, retirees, COBRA participants on or within 30 days <br />of the effective date. <br />. TPA Approval may be required <br />· Signed Disclosure Statement <br /> <br />As a reminder, the above documentation (with the exception of the Plan Document and census) must <br />be received and approved within two business days prior to the effective date (but no earlier than 15 <br />days prior) in order to confirm terms of coverage prior to the effective date. <br /> <br />We would also like to remind you that in order to receive reimbursement, your stop loss policy <br />obligates you and your TPA(s) to report loss data to (CARRIER) via ASL on a monthly basis. <br />This monthly report must list individuals that have exceeded or may exceed 50% of the deductible and, <br />if aggregate coverage has been purchased, a report showing the number of enrollees and paid claims <br />for that month and year-to-date. Other pertinent medical data, such as Large Case Management notes <br />should also be included. We have enclosed a suggested authorization letter for you to send to your <br />TPA(s). Please send this letter as soon as possible and copy Patrick Moore of ASL <br /> <br />Please note, monthly premium payments are due the first of each month (e.g., January premium is due <br />January 1). Please notify us immediately if this payment schedule is not feasible. Insurance <br />companies reserve the right to cancel coverage, if payment is not received within 31 days from the due <br />date, without further notification. <br /> <br />We appreciate the opportunity to place this coverage, and if you should have any questions, please do <br />not hesitate to call. <br /> <br />Sine;. r;ly, . ,.., . <br />~ ./ <' _J .r-- <br />I ~( I~ i/ ,)'L/l''- <br />Karen Rosati <br />Account Executive <br /> <br />cc: Walter Coolidge, Therese Simoncini, Patrick Moore, M. Sherman <br /> <br />endosures <br />