STOP LOSS COVERAGE. Stop loss coverage is designed to reimburse the employer for medical expenses payments (under a self-funded plan) which exceed specific limits during a coverage period. To protect the employer against large individual claims and unexpected high claim activity, Individual and Aggregate Stop Loss coverage is offered.

INDIVIDUAL STOP LOSS (ISL)

Under Individual Stop Loss, the Insurer will reimburse the employee the amount by which specific losses exceed the individual stop loss amount during the coverage period. The individual stop loss amount is shown on the summary page.

Specific losses are the total amount of eligible expenses incurred and paid by the employer for any one person covered under the employer's plan. ISL reimbursements are made immediately after satisfactory proof of payment is received.

AGGREGATE STOP LOSS (ASL)

Under Aggregate Stop Loss, the Insurer will reimburse the employer the amount by which aggregate losses exceed the aggregate attachment point during the coverage period. Aggregate losses are the total amount of eligible expenses incurred and paid for all persons covered under the employer's benefit plan, excluding any amounts reimbursed under the ISL.

THE AGGREGATE ATTACHMENT POINT

Is determined annually based on fixed dollar amounts for single and family units. At the beginning of each month during the coverage period, the attachment point is calculated as follows:

A. The single attachment factor and the family attachment factor are multiplied by the number of single and family units, respectively.

B. The resulting amounts are added together for each month of the coverage period.

THE MINIMUM ATTACHMENT POINT

Will be set at the beginning of the coverage period. The actual attachment point will be calculated at the end of the contract year. If the group decreases in size, the greater of the attachment point or the minimum attachment point set at the beginning of the year will apply. If the group increases in size, the aggregate attachment point will be increased accordingly. The aggregate and minimum attachment points based on the census provided are shown on the summary page. ASL reimbursements are made after the end of the contract period.

MAXIMUM BENEFIT

The maximum benefit the Insurer will pay under Individual Stop Loss is $1 million per person Lifetime. The maximum benefit the Insurer will pay under Aggregate Stop Loss is $1 million per contract period (Higher amounts available upon request.