Our goal in the Administration Department is to develop a long lasting, mutually respectful relationship with the TPAs and Brokers with whom we work. In doing so we can assure that the policyholder receives the most from their insurance products.

Please select from the following options:

Claims

We believe that early notification and working together are the most important elements in our relationship with TPAs to be sure the policyholder is getting the most of their claim dollars.

We have a knowledgeable and responsive claim staff to facilitate prompt reimbursement of claims. 

We also have established relationships with vendors for transplant networks, hospital audits, claim review, case management and out of network price negotiations. 

Specific Stop Loss Claims

When we should be notified:

50% Notifications.  A large claim notification should be submitted as soon as claims received, paid, pended, are at 50% of the Stop Loss Deductible. 

Specified Condition Notifications:.A large claim notification should be submitted as soon as TPA becomes aware of a condition that has the potential of exceeding 50% of the Stop Loss Deductible.  A recommended list of large claim diagnosis is included in the claim administration manual.

Once a reimbursement request is received:

A claim is reviewed initially to be sure that all necessary information is included. If additional information is needed, a letter is faxed or emailed to the TPA.   A follow up letter is sent periodically until required information is received.

Claim checks are mailed weekly and standard turnaround time is 10 working days.

Aggregate Stop Loss Claims

Monthly Notifications.   A loss ratio report should be submitted on a monthly basis. 

 If an aggregate claim needs to filed, an Aggregate claim form with all necessary documentation (as indicated in claims manual) should be submitted.  This information will be reviewed and claim processed accordingly.  All aggregate claims in excess of $40,000 require an on-site audit.

Premiums

We believe that flexibility is one of the most important elements in our relationship with TPAs and Brokers.

We have a knowledgeable and responsive accounting staff to facilitate prompt processing of premium checks, prompt payment of commission checks and a prompt response to your premium or commission inquiries.

Premiums can be reported on a gross basis (commissions not withheld) or on a net basis (commission withheld).  Commissions are paid the 15th of the following month in which premium payment is made.

All premiums are due and payable on the first day of each month.  Premiums not paid within 30 days are considered delinquent.  A delinquent notice will be sent on the 31st day. 

All checks should be made payable to:  ‘The Carrier’ c/o Medical Excess Underwriters, LLC .

Adjustments should be reported within 30 days.

Licensing

The Commission recipient (whether premiums are paid on a net or gross basis) must be licensed (appointed) with the carrier in the state in which the policy will be used.

To get appointed with the appropriate carrier a copy of a current license along with a completed Appointment Data Sheet must be submitted.

Policy Issue

MedEx issues policies once all sold case materials are received.  Sold case materials include signed stop loss application, signed disclosure statement,  binder premium equal to the first month’s premium, signed plan document, documents necessary for final underwriting and any other additional contingencies as stated in the proposal.