Insurance Policy Risk - AllianzCITY. OF DUBUQUE, IOWA
MEMORANDUM
January 29, 2001
TO:
FROM:
SUBJECT:
The Honorable Mayor and City Council Members
Michael C. Van Milligen, City Manager
Excess Risk Insurance Policy
Personnel Manager Randy Peck requests the City Council pass a motion authorizing approval of
the Excess Risk Insurance Policy with Allianz.
I concur with the recommendation and respectfully request Mayor and City Council approval.
MCVIWjh
Attachment
cc: Barry Lindahl, Corporation Counsel
Tim Moerman, Assistant City Manager
Randy Peck, Personnel Manager
Sent ~y:.CITY OF DUBUQUE
319 589 4149;
Allianz Life Insurance Company of North America
1750 Henne0in Avenue
Minneapolis, MN 55403-2195
A Stock Company
(Herein Called the Company)
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Rllianz
POLICYHOLDER:
GROUP POLICY(lES): 20'/74-004
EFFECTIVE DATE: July 1, 2000
POLICY AI~INIVERBARY: July 1
Allianz Life Employers' Insurance TmsL Fimt Alabama Bank of
Birmingham, Trustee -City of Dobuque, Iowa
12:01 a.m. at the address ct the Policyholder
each year thereafter
The Group Policy is delivered in the State of Alabama. .,
The Policy is issued in consideration of the Application of the Policyholder and payment of the premiums
by the Policyholder as provided in the Policy. The first premium is due and payable on the Effective Date
of the Policy and subsequent premiums are due and payable in accordance with the Premium Provisions
so long a~ the Policy remains in force.
The Policy is subject 1o all the conditions and provisions set forth on this and the subsequent pages, which
are msde a part of the Group Policy,
IN WITNESS WHEREOF, ALLIANZ LIFE !NSUP~NCE COMPANY OF NORTH AMERICA has executed
this Policy at Minneapolis, Minnesota on the 16"' day of October, 2000.
vice
GROUP INSURANCE POLICY--NON. PARTICIPATING
This Policy is not in lieu of and does not affect
any requirement lot Worker's Compensation insurance.
GSLP8 (9-89)
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CONTENTS
The Secti~s ol ~he Policy appear in the orcler set forr~ below:
SCHEDULE OF EXCESS RISK INSURANCE BENEFIT
DEFINITIONS
AGGREGATE EXCESS RISK INSURANCE BENEFIT
SPECIFIC EXCESS RISK INSURANCE BENEFIT
POLICY TERMINATION
CONVERSION PRIVILEGE FOR COVERED PERSONS
MISCELLANEOUS PROVISIONS
CLAIM PROVISIONS
EXTENSION OF BENEFITS
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SCHEDULE OF EXCESS RISK INSURANCE
AGGREGATE EXCESS RISK INSURANCE
1. Aggregate Monthly Factor
~ Single/Composite
$658.37 Family
2. Number of Covered Units
85 Single/Composite
437 Family
The Number of Covered Units are subject to change based on the actual enrollment for the first
Policy Month.
3. Minimum Annual Aggregate Attachment Point percentage 85=/=
4. Reimbursement Factor (Company Limit of Liability)
100% of payments in excess of the Annual-Aggregate Attachment Point, to a maximum of
$1,000,000.00.
AGGREGATE TERMINAL LIABILITY
1. Terminal L/ability Option ~cluded? Yes ( ) No (X)
SPECIFIC EXCESS RISK INSURANCE
1. Specific Attachment Point $60,000.00 per Policy Year.
However, for a Covered Transplant Procedure rendered at a Transplant Network Hospital the
Specific Attachment Point will be reduced to $50,000.00. Such reduction is a one time reduction for
each Covered Transplant procedure and will be apptied to the Policy Year in which the Covered
Transplant Procedure takes place (as determined by the date of actual surgical transplant of a body
organ or the date of reinfusion of bone marrow or peripheral stem cells). Retransplants are
considered a new Covered Transplant Procedure.
The Company is not responsible for any Covered Person's decision to receive treatment, services
or suppties from a Transplant Network Hospital nor does the Company make wan'ants or
representations for the qualifications of providers or treatment, services or supplies provided by a
Transplant Network Hospital.
Covej'ed Transplant Procedure: Means the human to human organ or tissue transplant procedure
considered reimbursable under the terms of this Policy.
Transplant Network Hospital: Means a medical facility participating in the LifeTrac Network of
hospitals at the time of admission for the transplant..
2. Reimbursement Factor (Company Limit of Liability)
100% of payments in excess of the Specific Atlachment Point, to a Specific Indiviciual Max~num of
Sl ,OOO,ODO.O0.
GSLP6-01-01 (9-89)
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CONVERSION PRIVILEGE FOR COVERED PERSONS
Conversion Option included? Yes (~) No (X)
LIMITATIONS
The Company will not reimburse the Policyholder for:
Payments for treatmentS, procedures, cievices, drugs or medicines which the Company determines are
experimental or investigationaL This means that one or more of the following is true:
1. the device, drug or medicine cannot be lawfully marketed withOUt approval of the U.S. Food and
Orug Administration and approval for marketing has not been given at the time the device, drug or
medicine is furnished.
2. reliable evidence shows that the treatment, procedure, device, drug or medicine is the subject .of
ongoing phase I. Il, or III clinical trials cr under study to determine its maximum tolerated dose. its
toxicity, its safety, its efficacy, or its efficacy as compared with the standard means of treatment or
diagnosis.
3. reliable evidence shows that the consensus of opinion among experts regarding the treatment.
procedure, device, drug or medicine is that rue[her studies or clinical trials are necessary to
determine its maximum tolerated doss, it toxicity, its safety, its efficacy, or its efficacy as compared
with the standard means of treatment or diagnosis.
Reliable evidence means only published reports and articles in the authoritative medical and scientific
literature: the written protocol or protocols used by the treating facili~ or the protocol(s) of another facility
studying substantially the same treatment, procedure, device, drug ar medicine; or the written informed
consent used by the treating facility or by another facility studying substantially the same treatment.
procedure· device, drug er medicine,
In addition, no reimbursement is available for payments of any: (a) treatments, services or supplies that
are educational or provided primarily for research; ar (b) treatments, procedures, devices, drugs or
medicines er other expense relating to transplants of nan-human organs.
The Company's liability under this Poticy will not be increased if the Plan provides more liberal Limitations
provisions.
EMPLOYEE BENEFIT PLAN CLAIMS ADMINISTRATOR (Generally referrad to herein as the
"Administrator'. However the term "Administrator'. as used herein, does not refer to the plan administrator
as used in ti'lo Employee Retirement Income Security Act of 1974.)
Name of Administrator HMS preferred Health Choices. In.c.
GSLPS-0 t-01 (9-89)
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5
DEFINITIONS
ANNUAL AGGREGATE ATTACHMENT POINT for any one Policy Year (or any fraction thereof if the
Policy terminates during the Policy Year) means the tolat of the number of Covered Units each
multiplied by suC~t Covered Units' corresDonding Aggregate Monthly Factor(s), or the Minimum Annual
Aggregate Attachment Point, whichever is greater.
COVERED PERSON means each person, ind~widually, who is covered under the Plan.
COVERED UNIT means an employee, an employee with dependents, or such other defined unit ss
agreed upon between the Company and the Policyholder, who is covered under the Plan.
EMPLOYEE BENEFIT PLAN (also called the Plan) means the welfare benefits the Policyholder has
agreecl to provide under a wdEen plan of benefits for his employees and their dependents, ir~luding any
amendments to such plan Of benerff~.
FUNDED means the Polisy~olde~' must maintain adequate lunds in the claim account on tl~e last working
day Of the Policy Year in orde[ ~r drafts or checks drawn agains~ the account to be reimbursed.
ISSUED means, in part. in accordance with, Section 3-102 of The Uniform Commeroial Code, the first
delivery of an instrument to a ho~ler or a remitter.
MINIMUM ANNUAl- AGGREGATE ATTACHMENT POINT means an amount equal to the percent
specified in the Schedule of Ex,ess Risk Insurance of ~e Monthly Aggregate Attachment Point times 12,
rega~lless of whether the Policy terminates prior to the end of a Policy Year. For the first Policy Year. the
Monthly Aggregate Attachment Point ~sed will be that cf the fi~at Policy Month and for subsequent Policy
Years, the Monthly Aggregate Attachment Point used will be that of the Numher of Covered Units of the
12th Policy Month of the preceding Policy Year, multiplied by the Aggregate Monthly Factor(s) of the first
Policy Month of the succeeding Policy Year.
MONTHLY AGGREGATE ATTACHMENT POINT means the total Number of Covered Units for that given
Policy Month multiplied by tl~e corresponding Aggregate Momhly Factor(s).
NUMBER OF COVERED UNITS means the total number of Covere(t Units existing in any one Policy
Month. The Number cf Covered Units for the first Policy Month of tho first PoliCy Year is shown in the
Schedule of E:~cess Risk Insurance. The Number of Covered Units for subsequent Policy Months anct/or
Policy Years will be dete~Tflined on a monthly basis in accordance with the definition of Covered Unit.
PAID means drafts or checks that are Issued on an account that is Funded.
REIMBURSEMENT FACTOR means the pementsga specified in the Schedule of Excess Riel( insurance.
Separate Reimbursement Factors may apply to Aggregate Excess Risk insurance and Specific Excess
Risk Insurance.
SPECIFIC A'I'I'ACHMENT POINT means the dollar amount specified in the Schedule of Excess Risk
InsuranCe. For each Covered Person, the Specific AEachment Point will apply separately each Policy
Year. The Specific Attachment Point for subsequent Policy Years will be determined annually by the
Company.
If this policy terminates cluring any Policy Year, the Specific Attachment Point will be calculated as if the
Policy had remained in effect for the full Policy Year.
GSLP8-02-02
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SPECIFIC INDIVIDUAL MAXIMUM is [he amount specified in the Schedule of Excess Risk Insurance and
means the maximum liability of the ,Company while this Policy is in effect for Ihe Excess Risk Benefit for
any Covered Person.
AGGREGATE EXCESS RISK INSURANCE BENEFIT
AGGREGATE EXCESS RISK INSURANCE ON A PAID BASIS. for any Policy Year or fraction thereof, is
the Plan Benefits On A Paid Basis less:
1. the Annual Aggregate Attachment Point; and
2. any benetits wflich have been or will be reimbursed by the Company under the Specific Excess Risk
Insurance Benefit;
multiplied by the Reimbursement Factor and subject to any maximum shown under Aggregats Excess
Risk Insurarlce in the Schedule of Excess Risk Insurance.
Plan Benefits On A Paid Basis are the total amount of benefits to which Covered Persons become entitled
under the Plan. subj6~'~ to shy terms, conditions and limitations shown in this Policy. For each Policy Year,
such amount of boner?ts shall only include the actual amount of benefits; (a) incurred on or after the
Effective Date of this Policy;. (b) Paid while this Policy is in force; and (c) Paid during that Policy Year.
Such amount of benelits shall not include deductibles, ~oinsurance amounts, any other amounts due to a
reduction in beneres as a result ct failure to obtain and follow cost containment requirements, or any other
expenses which are not reimbursable under the terms of the Plan, nor expenses which are reimbumable
to the Plan or Policyholder from any other seume. An expense will be considered t~ be incurred at
time the son,ice, or the supply to which it relates, is provided, No cost of claim payment; expanse of
litigation; punitive, exernl31a~, or consequontial damages with individual claimants; expense of hospital
audits; or cost containment fees shall be included.
The Company will pay to the Policyholder. after receipt of the p~f of loss and request for reimbursement,
the Aggregate Excess Risk Insurance Benefit, if any. within a reasonable time after the end of each Policy
Year. or within a reasonable time after the end of the peded under the Aggregate Terminal Liability
p~ovision, whichever is later, subject to the Campany's right to audit the records of the Pcolicyholder and
the Administrator. if the Policy tsrminates during the Policy Year. such payment will be made within a
reasonable time after date of such termination.
SPECIFIC EXCESS RISK INSURANCE BENEFIT
SPECIFIC EXCESS RISK INSURANCE ON A PAID BASIS. for e~3y Policy Year. or fraction thereof, is the
Plan Benefits On A Patti Basis with regaml to a Covered Person, less the Specific Attachmem Point,
multiplied by the applL'-~h!e Reimbursement Factor, and subject to the Specific Individual Maximum.
Plan Benefits On A Paid Sasis are the to~al amount of benefits to which Covered Persons become entitled
under the 151an, subject to any terms, conditions and limitations shown in this Policy. For each Policy Year.
such amount cf banefits shall only include the actual amount of benefits incurred on or after the Effective
Date of this Policy and Paid during that Policy Year. Such amount of benefits shall not include deductibles,
coinsurance amounts, any other amounts due to a reduction in benefits aa a result of failure ~o obtain and
tallow cost containment requirements, or any other expenses which are not reimbursable under the terms
al the Plan, nor expenses which are reimbursable to the Plan or Policyholder from any other sourCe, An
expense wilt be considered to be incurre~ at the lime fha servi~e, or the supply te whiCh it relates, is
provided. No cost of claim payment; expense of litigation; punitive, exemplary, or consequential damages
wEh individual claimants; or expense ol hospital audits; or cost containment fees shall be included. A
GSLP8-02-02 (2-90)
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benefit sllail be considered Paid during a Policy Year if a c, heOk has been Issued on an account ~ha[ is
adequately Funded.
The Company will pay to the Policyholder, after receipt of the proof of loss and requesl for reimbursement,
the Specific Excess Risk Insurance Benefit, if any, within a reasonable time.
POLICY TERMINATION
The Policy and ail benefits hereunder will terminate upon the earliest of the following dates'
1. The end of any Grace Pe~im:t, if no premium is paid before thai Grace Pedod expires (in which case
the Company may require a pro-rate premium payment or adjustment for any period of ~ims that
insurance remained in effect}.
2. The premium due date next following receipt by the Company of wdtten notice from the Policyholder
that the Policy is to be terminated.
3. The Iss~ day of the Palicy Year in which the Company gives a 30-day notice to the Poli~oldar (hal
the Policy is to be terminal.
4. The date of termination of the Employee Benefit Plan.
5. The date that the number of Employees covered under the Plan becomes less than 35.
6. The date of commencement of any proceeding concerning the Policyholder under any bankruptcy
laws.
In addition to the Termination previsions listed above, the Policy st~all automatically terminate upon
cancellation of the agreement between the Policyholder and the Administrator, unless the Company has,
prior tn such cancellation, agreed in writing ~o the Policyholders designation of a successor Administrator.
GSLPS-02-02 (2-90)
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8
CONVERSION PRIVILEGE FOR COVERED PERSONS
in the event the Conversion Privilege For Covered Persons is applicable as stated in the Schedule of
Excess Risk insurance, such Covered Person shall be entitled to make al~plication for medical conversion
coverage of the ~ype Ihen avaltable from the Company, provided he has exhausted his maximum
continuation peded, as provided under the Consolidated Omnibus Budget Reconciliation Act of 1985 er
amended thereafter, and further provided the date such coverage ceased is prior to the date of termination
o! this Policy. In the event the Covered Person applying for the group certificate has dependents who are
also Covered Persons, suct3 group ceniticate will, except as hereinaEer provided, also cover such
dependents. The Company may issue a separate convemicn certificate to any such depandent.
Issuance of the grnup certificate will be subject to all of the following conditions:
1. A group certifk::ate may only be issued to a person who is a resident of the United States and who
has bean covered under a program of medical care expense benefits provided through or by the
Policyholder for at least six consecutive months.
2. Written application for conversion and the first premium for the group certificate must be delivered or
mailed to the Company at its Home Office within 31 days alter the date on which the Covered
Person's coverage under the Employee Benefit Plan terminated. No evidence of insurability will be
required.
3. The group certificate shall be one customarily issued by the Company at the then curt, ant rates ami
el the type available for conversion. The group certificate need not duplicate the benefits of the Plan.
4, The group certificate will become effective on the day after the date on which coverage under the
Employee Benefit Plan ceases.
Any parson who is covered by or eligible for Medicare is net entitlert to make application for a conversion
certificate. The Company shall not be required to issue a converted cellificate covering any person if; (i)
such person is covered for similar benefits by another hospital, surgical, medical or major medicaJ expense
policy or hospital er medical service subsci~ber contract or medical practice or othe¢ prepayment plan or by
a. ny other plan or program; or (ii) such person is eligible for similar benefits (whether or not covered
Iherefore) under any alTangements of coverage for individuals in a group, whether on an insured basis or
uninsured basis; or (iii) similar benelits are provided for or available to such person, pursuant to or in
~ccordance with the requirements of any statute, and the benefits provided or available under ttre sources
referred to in (i}; (ii}; and (ii~ above for sucl't person together with the converted canificata would result in
over-insurance according to the Company's standards relating to group policies.
MISCELLANEOUS PROVISIONS
LIABILITY AND INDEMNIFICATION: The Company's liability under this Policy is limited to reimbursing
the Policyholder. in whole or in part, if at all, for payments the Policyholder has made lot Covered Persons
lot expenses covered under the Plan. The Company is not liable tor any costs the Policyholder incurs
because-'o! contested claims under the Plan. The Company is not liable for punitive, exemplary or
consequential damages. The Policyholder holds the Company harmless trom damages el any kind, which
ara not caused by the Company's own acts or omissions. This Policy creates no right or legal relation
whatever between the Company and any Covered Person.
POLtCY YEAR, POLICY MONTH and PREMIUM DUE DATES: Policy Year, Policy Month and Premium
Duo Dates are determined from the Policy Elfective Data. Each new interval will begin on a day that
corresponds numerically with the Policy EIfective DAte. If there is no such day in any applicable month,
th,3n tho I~st d.~y et the month will be used,
GSLPS-03-0t
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PREMIUM PROVISIONS: Ea~ premium for this Policy is payable on or before its due date at the Home
Office of the Company or to the A~minisa'ator. Payment of a premium shall not maintain this Policy in torce
beyond the period for which such premium is paid, except as otherwise stated in this Policy provision.
A Grace Period of 31 days will be allowed for the payment of each premium due attar the first.
The Policyholder will be liable for any premiu~ t~y~,~ assessed at any time against the Company beyond
any ~xes which may be payable on the premium received by the Company.
Any correction to the Specific or Aggregate premium or to the Covered Units for the preceding Policy Year,
must be reposed to the Company within 60 clays after the 12th Policy Month of the preceding Policy Year.
If this Policy terminates during any Policy Year, there will be a refun~ of premium paid but unearned,
based on the Company rules then in effect for refunding premium paid but unearned.
COMPUTATION OF PREMIUMS: The Company reserves the right to change the premtum and aggregate
factors on any premium due data:
1. when the terms of this Policy or Plan are changed; or
2. when a division, a subsidiary or an affiliated company is added or belefad to this Policy; or
3. when an increase or becmase in the number of Covered Units under the Policy exceed 20% over
any period of three cor--=~tive months; or
4. for any reason other than those stated above. However, the Company's right to change premiums
and aggregate factors tor this item 4, will be limited to ones in any twelve-month period.
A 31-day advance written notice of any such change rnus~ be given to the Pollcyfiolder.
PoucY NONPARTICIPATING: This Policy is nonparticip~ing and does ncr entitle the Policyholder to
share in the su~lus earnings of the Company.
RENEWAL PRP/ILEGE: On each Policy anniversary, this Policy may be renewed by the Policyholder,
under the ten~s offered by the C,¢=mpany and subject to the provisions of this Policy, Ior a further term of
one year subjeu't to the following:
1. The Minimum Annual Aggregate Attachment Point will be based upon the enrollment for the 12th
Policy Month of the pre~ling Policy Year;, and
2. The Company reserves the r[ghi[ to recalculate the Aggregate premium rate and the Aggregate
Momhly Factor(s) if the last two months of claims in the current Policy Year varies by more than 10%
of the average monthly Paid claims tor the previous ten months.
DATA REQUIRED: The Policyholder will maintain adequate recorels acceptable to the Company for
insurance coverage under the Policy and any claims tiled under the Employee Benefit Plan. While this
Policy is in force and for a period of seven years a~ter termination of the Por~cy, the Policyholder shall
mal(e ~11 such records available to the Company for period~ examination as needed, either at the
Administrator's place of business or at the Company·
MISSTATED DATA: If information used in determining the premiums or factors is misstated by the
Policyholder or the Administrator, the Company reserves the right to adjust the premiums or factors in
accordance with the correct data.
CLERICAL. ERROR: Clerical error, whether by the Policyholder or by the Company, in keeping any
records pertaining to the coverage, will not invalidate coverage otherwise v~iidly in force or continue
coverage othen~ise vatidly terminated.
GSLPS-03-01 (9-89)
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ENTIRE CONTRACT, STATEMENTS NOT WARRANTIES, CHANGES: This Policy and the Application
of the Policyholder (a copy of which is attached hereto whe~ issued) shall constitute the entire contract
between the parties, and all statements made by Ihe Policyholder will be deemed representations and not
warranties, and no such slatement shall be used in defense to a claim under the Policy unless it is
contained in the wr~en signed Application.
Only an Officer of the Company is authorized to alter this Policy, or to waive any of the Company's rights
to requirements and then only in writing. No such alteratiOn of this Policy shall be valid unless endorsed on
or attached to this Policy. Neither the Adminislz~tor nor any other agent has authority to alter this Policy or
to waive any of its provisions.
NOTICE: For the purpose of any notice required from the Company under the provisions of this Policy,
notice to the Administrator shall be considered notice to the Policyholder and notice to the Polic!fnolder
shall be considered notice to the Administrator.
AMENDMENTS TO THE POLICY: This Policy may be amended at any time with the mutual written
consent of the Company and the Policyholder.
AMENDMENTS TO THE PLAN AND/OR ADMINISTRATIVE AGREEMENT: No change Ia the Employee
Benefit Plan shall affect this Policy without the prior written consent of the Company. Notice of amendment
to the Employee Benefit Plan must be given to the Company in writing at its Home Office at least 31 days
prior to the Effective Data of the amendment. In the event that such advance written notice is not received
by the Company in a~ordance with this pro~4siOn, ~he Company shall be liable to pay benefits hereunder,
until notice is received, and approval is given, as if the Employee Benefit Plan had not been amended.
Furthen~ora, the Policyholder will provide to the Company, if requested, a copy of the Policyholder'$
written agreement, and al! amendments thereto, with its Administrator, and the Policyholder agrees that a
copy of any future amendment to. or cha~nge in, said agreement shall be provided to the Company prior to
the time if becomes effect[va.
SUBROGATION: The Policyholder is obligated to pursue any subrogation possibilities. In the event the
Policyholder recovers damages, expenses or benefits fi'om a thi~ party, the recovered amount cannot be
used to meet an attachment point until amounts in excess of the applicable attachment point(s) have been
reimbursed to the Company.
Furthermore. the Company will not reimburse the recoverecl amount. If the Company has reimbursed the
PoliCyholder for all or pan of a particular payment and that payment is later recovered from a third party,
the Policyholder must repety the Company to the extant of the reimbursomen! regardless of whether the
PoliCy is still in force on the date of recovery. Repayment may be reduced by the reasonable and
necessary expenses incurred by the Policyholder in recovering from the third party.
CLAIM PROVISIONS
PAYMENT OF CLAIMS: The Company shall have sole authority to pay or deny claims under this Policy.
All Berretta ss they become payable under the Policy will be pail to the Policyholder.
The Company will reimburse the Policyholder for charges incurred in connection with cost cc~nteinment
fees, pravided approval was ohlained prior to such expense being incurred.
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11
LEGAL ACTION: NO action at la.w or in equity shall be brought to recover on this Policy prior to the
expiration of 60 days after wdtten proof of loss has been fumishect in accordance with the requirements of
this Policy. NO such action shall be brought after the expiration of 3 years after the time written proof of
loss is required to be furnished.
CONFORMI'T~ WITH STATE ~rATUTES: if any time limitatio~ of this Policy with respect to giving notice
of claim or furnishing prool of loss or bringing action is less than that permitted by the law of the state in
which the Policyholder resides, such limitation is hereby extended t~ agree w~h the minimum period
permuted by such law.
AUDITS: The Company shall have the dgh! to inspecl and audit all records and procedures of the
Policyholder and the Administrator and shall have the right to determine if any c~aim is properly chargeable
against any attachment point as defined in this Policy, If there is any conflict between the Administrators
decision in paying claims for the Plan and the Company's decision in insuring such claims above the
applicable attachment point, the Company has the right to make the final decision with respect to
reimbursement of claims above the applicable at~.chmant point.
The Policyholder or the Adminis~'ator shall submit on a timely basis all reports requested by the Company,
including, but net limited to, periodic estimates of pending claims and actual Paid claims.
The Company, if in agreement, will reimburse the Policyhot(ter tor expanses incurred in connection with a
hospital audit, provided approval was ob~ined pdor to such expenses being incurred.
All records shall be made available to the Company either at the Administrator's place of business or at the
Company.
NOTICE OF CLAIM: In addition to any other notices required by this Policy, the Policyholder or the
Adminisffator must submit to the Company, on a form approved by the Company, written notification of a
pandihg claim au the point which ex~=eee~s 75% of the Specific or Aggregate Atlachment Point specified in
the Schedule of Excess Risk Insurance. This notification must be given when the Policyholder or the
Administrator knew or should have known of such pending claim.
NOTICE OF LEGAL ACTION: Any objection, notice of legal action, ar complaint received on a claim
processed by the Policyholder or the Administrator, anti on which it reasonal:)ly appears benefits will be
payable uoder this PoI~'Y, shall be brought to the immediate attention of the Claims Department of the
Company.
EXTENSION OF BENEFITS
There is no Extension of Benefits provision for either Aggregate Excess Risk Insurance Benefit or S@ecific
Excess Risk Insurance BanefUL
GSLPS-04-01 (2-90)