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Aggregate Claim Submission Provision

Submit the following when requesting a Year-End Aggregate Reimbursement.

• A completed and signed Reimbursement Request.
• A Paid Claims Report or a list of paid claims for the reporting period which includes:
  a. Name of employee/participant
  b. Name of patient
  c. Incurred dates of service for each payment
  d. Accumulated total for each individual.
• A Check Register which includes:
  a. Check numbers
  b. Amount of each check
  c. Date of payment
  d. Name of Payee
• A complete Census Report for the excess Contract year
• An Aggregate Excess Loss Report
• Copies of the Prescription Card Program invoice statements (if your Contract covers prescription card service or similar drug coverage)
• Identify administrative fees, non-contractual payments and any exception payments made by the plan
• A listing/report that indicates voids and refunds for the contract year.
• Aggregate Request Form
  
  BEST Re may request employer-funding verification. We may also schedule an on-site audit. If such a field audit is determined to be necessary, BEST Re will contact you personally with further instructions.

Aggregate Accommodation Option

Although the stop-loss contract is a reimbursement contract and is not to be deemed “insurance”, Aggregate Advance Funding is an optional feature that can be added to the Excess Risk Reimbursement Contract we issue. This option is designed to provide the employer with funding assistance, subject to premiums being current and to the appropriate pro-rated aggregate retention amount.

When requesting an aggregate advance on behalf of your client, the administrator must agree to the following terms and conditions:

• Only one advance will be made per calendar month and subject to a minimum of $5,000.
• The aggregate retention must be paid prior to any advance.
• Checks issued by the Plan, which accumulate towards the employer’s aggregate retention, must be released to the payees prior to requesting an advance.
• All claims submitted for advance funding, must be identified as such.
• A list of payments to which the advance applies must be provided with your request.
• Advanced funds must be paid directly to the provider for which the advance payment was requested.
• Once the advance is received and claims are paid, the check numbers, dates and amounts, if not previously provided, must be reported to BEST Re.
• It is imperative that administrator checks, which have been issued for the claims in which the advance request is made, can be verified.
• The Administrator will provide all services and satisfy all reporting requirements as if the claim has been funded/paid.
• Requests for an advance must be made no later than 20 days after the month for which the advance is being requested
• Provide all documents required with a year-end request.
• Aggregate Request Form