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Questions

We have provided the following frequently asked questions as a courtesy to our clients. The answers provided are for general information and should be viewed as such. If you do not find the information you are looking for or need more specific information, please feel free to contact our office at (601) 427-0235.

Keywords:

Q. What carriers does Excess Risk represent and what are their A.M. Best ratings?

A. Excess Risk provides Excess Loss coverage through Ironshore Indemnity, which is rated “A-” (Excellent) by A.M. Best and Companion Life Insurance which is rated "A+" (Superior) by A.M. Best.



Q. What is Excess Risk’s turn around time on New Business proposals?

A. Excess Risk’s normal turn around time for proposals with all required information is 10 business days. However, we can often provide proposals in a shorter time period.



Q. When is coverage considered “bound” on Excess Loss coverage?

A. The initial step to bind coverage will be to complete Excess Risk’s Confirmation of Stop Loss form and to complete and sign the Disclosure Statement.  These documents, along with the final months of claims experience, should be submitted to Excess Risk for review.  Once approved by Excess Risk, you will receive written notification in writing and an Excess Loss Application will be released including the terms agreed upon.

Coverage is not considered “bound” until the signed Application is received by Excess Risk.  A break of no more than 10 working days should occur from the date the Application is released and the date the Application is received by Excess Risk.  Longer time periods may require additional underwriting.



Q. How soon can I bind my Excess Loss coverage?

A. Excess Risk makes it a standard practice to be able to bind coverage no more 30 days prior to the proposed effective date.  However, on a case-by-case basis, Excess Risk may be able to bind coverage at time periods longer than 30 days prior to the effective date.



Q. What is the definition of “Paid” in your Excess Loss policy?

A. Under both the Ironshore and Companion Life policies issued by Excess Risk, a claim is said to be “paid” when 1) the administrator tenders payment and 2) the account on which the payment is drawn contains, and continues to contain, sufficient funds to honor the payment.



Q. Does Excess Risk offer an Aggregating Specific and how does it work?

A. Yes, Excess Risk can offer an Aggregating Specific on many of our cases as an alternative to higher premiums or as a way for self-funded employers to share in the claims risk in return for reduced premium.

For an employer with an Aggregating Specific, that employer is responsible for all claims over the stated Specific deductible up to a certain amount (the Aggregating Specific deductible).  In return, the self-funded employer receives a certain amount of premium relief for sharing in the claims risk of the Aggregating Specific.

Example: Employer A has a Specific deductible of $25,000 and an Aggregating Specific deductible of $30,000. As the policy year progresses, Employer A has three Specific breaches – First, Claimant 1 with $35,000 in total paid claims.  Second, Claimant 2 has $50,000 in total paid claims.  Finally, Claimant 3 has $30,000 in total paid claims. The reinsurer would reimburse the Specific claims as follows:

  1. Claimant 1 - $10,000 in excess of the $25,000 Specific.  All $10,000 would be applied toward satisfaction of the Aggregating Specific deductible.  NO Specific reimbursement would be made.
  2. Claimant 2 - $25,000 in excess of the $25,000 Specific.  $20,000 is applied to satisfy the remaining Aggregating Specific deductible ($30,000 - $10,000 from Clmt 1 = $20,000).  $5000 Specific reimbursement made to Employer A from reinsurer.
  3. Claimant 3 - $5000 in excess of the $25,000 Specific.  Aggregating Specific is satisfied.  $5000 Specific reimbursement made to Employer A from reinsurer.

Employer A receives a reduction in the Specific premium in return for sharing the claims risk of the Aggregating Specific.



Q. Does my policy include a Specific Advance feature?

A. No. Excess Risk doesn’t offer Specific Advance on the policies it sells.  However, Excess Risk can provide an Administrative Accommodation to advance Specific claims where special circumstances apply that require quick claims turn around such as large hospital claims and negotiated discounts.  In each instance, the employer must fully fund the Specific deductible and Excess Risk will advance only the amounts in excess of the Specific.  This Administrative Accommodation is provided on a case-by-case basis.



Q. Where do I send claims for reimbursement?
A. All claim reimbursement requests should be sent to our mailing address below.

Excess Risk Reinsurance, Inc.
Attention: Claims
P.O. Box 1170
Ridgeland, MS 39158-1170


Q. What is the turn around time on claim reimbursement requests?

A. The normal turn around time for complete claim reimbursement requests, requiring no additional information, is approximately 10 working days.  The turn around time may be longer if Excess Risk requests information from the administrator and the reimbursement request is pended for additional information.



Q. What do I need to send with a reimbursement request?

A. Information needed is as follows:

1. Specific reimbursement

  • Copy of enrollment form or print screen of enrollment information.
  • If COBRA continuee, COBRA effective date, record of COBRA payments and prior creditable coverage information, if applicable.
  • Copies of all bills with corresponding EOB’s.
  • Outpatient bills exceeding $5000 and Inpatient bills exceeding $10,000 must have an itemized statement included.
  • Documentation showing proof of deductible and out of pocket satisfaction for all years included in the policy year.
  • Results of current COB investigations.
  • Pre-certification or authorization for all claims, as appropriate.
  • Signed subrogation recovery agreement, if applicable, including original date of loss and complete accident details.

2. Aggregate reimbursement:

  • Paid claims detail for all coverage types for the policy period.
  • Detailed check register for all coverage types for the policy period.
  • Paid claims detail for all claimants in excess of individual Aggregate limit.
  • Paid claims detail for all out of contract claims for policy period.
  • Paid claims detail for all Voids / Refunds for policy period.
  • Paid claims detail for all claims in run-in / run-out period.
  • Completed Aggregate Request Form.


Q. Where do I send 50% / Potential Catastrophic Notices?

A. 50% / Potential Catastrophic Notices should be sent to our Medical Manager, Managed Care Associates, attention Kathy Sellers. They may be sent via email to ksellers@mcams.biz or via fax at (601) 427-0245. The 50% Notice may be downloaded from this website.

50% / Potential Catastrophic Notices may also be sent to our office via fax at (601) 427-0245.



Q. Do I need to have an insurance license to get commission on a case I’ve sold?

A. Agencies, agents or agents associated with a group must hold an active A&H license in the resident state of the employer group and be appointed with Ironshore or Companion Life to receive commission.

The Agency, Agent or Broker listed on the Application as the “Broker / Agent of Record” and anyone receiving commissions for the group must complete the appropriate appointment paperwork for either Ironshore or Companion and return the original completed form along with a copy of the Agency, Agent or Broker’s license and a copy of their E&O Declarations Page to Excess Risk.



Q. Once coverage is bound, where do I send premiums?
A. Premium for Excess Loss coverage is payable to either Ironshore Indemnity or Companion Life Insurance, as applicable, and should be sent to the following address:

Excess Risk Reinsurance
P.O. Box 1170
Ridgeland, MS 39158-1170


Q. What are your office hours and how can I get in contact with you?

A. Our office hours are Monday – Thursday, 8:00 a.m – 5:00 p.m. and Friday, 8:00 a.m. – 4:00 p.m. All hours are Central Time. Please feel free to call us at (601) 427-0235 or email us at info@errms.net .



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