1988-040-RES WHEREAS, the City Council of the City of Paris, is desirous of continuing to provide health coverage for

Home Browse Search

Mr. Gene Anderson September 3, 1987 Page two C. If Item IV (a) or IV (b) of the Exhibit is indicated "applied for," Blue Cross and Blue Shield of Texas Inc. will furnish the Employer a Specific Health stop LOSS Benefit report after the end of each month occurring within an Accounting Period in which Specific Health stop Loss Benefits were paid. The report will detail for the month cumulative Specific Health stop Loss Benefits, Cumulative Draft Authority, Health Benefit Checks and all other data required for settlement, as provided herein. within 10 days after issuance of such report, Blue Cross and Blue Shield of Texas, Inc. will settle with the Employer for any Specific Health stop Loss Benefits involved. Based on the report, the following appl ies: 1. If the report reflects that the Cumulative Draft Authority was exceeded, the amount of Specific Health stop Loss Benefits paid during the month will be compared to that excess amount. If the Specific Health Stop Loss Benefit amount is greater than said excess amount, an amount equal to the difference between those two amounts will be paid to the Employer and the Suspense Account will be reduced by an amount equal to said excess amount. If the Specific Health Stop Loss Benefit amount is less than said excess amount, the Suspense Account will be reduced by an amount equal to the Specific Health stop Loss Benefi t amount. 2. If the report reflects that the Cumulative Draft Authori ty was not exceeded for the month, an amount equal to the amount of Specific Health stop Loss Benefits paid during the month will be paid to the Employer. 3. To the extent that amounts are paid to the Employer by Blue Cross and Blue Shield of Texas, Inc. as a result of any monthly Specific Health stop Loss Benefit settlement, as described in paragraphs 1 or 2 above, available Draft Authority will be restored by those amounts.