COVERAGE PERIOD

ISL. If a 12/12 contract is selected, specific losses must be incurred and paid within the 12 month coverage period. If a 12/15 contract is selected, specific losses must be incurred within the 12 month coverage period and paid within that period or the following 90 days.

ASL. Aggregated losses must be incurred and paid within the 12 month coverage period, regardless of the ISL selected. An expense is considered to be incurred on the date the service is rendered or the supply is obtained. An expense is considered to be paid on the date the check or draft is issued. At the end of the coverage period, coverage may be continued for successible periods of 12 months subject to the Insurer's approval.

SPECIFIC AND AGGREGATE LOSS EXCLUSIONS
Specific and Aggregate Losses do not include the following:

Plan deductibles;

Plan coinsurance amounts

Expenses which are not payable under the terms of the employer's benefit plan agreed to by the Insurance Company or

Cost of claim payment or litigation expenses.

STOP LOSS EXCLUSIONS
Liability is limited to reimbursement for payments that have been made to persons covered under the employer's benefit plan for covered medical expenses. Stop Loss benefits will not be paid for the following expenses:

Expenses due to sickness or injury caused by war;

Expenses incurred while the plan is not in force for a covered person;

Expenses which are in excess of the usual or customary charge for a service in the locality where performed;

Expenses which are in excess of the employer's plan benefits;

Expenses resulting from the employer's failure to comply with any legal statute or regulation;

Liability assumed by the employer under any contract or service agreement other than the plan agreed to by the insurance company.

TERMINATION OF STOP LOSS INSURANCE
Stop Loss Insurance will terminate:

If the employer fails to pay premiums within the 31 days following the premium due date;

On the first premium due date after the employer notifies in writing that cancellation is requested;

If the employer fails to provide, on a prompt basis, any required information, fails to perform any other obligations pertaining to this policy, or knowingly files claims with false information (at least 30 days advance notice of termination will be provided to the employer);

On the expiration date of the coverage period unless the insurance company agrees to continue coverage for an additional 12 month period.