Frequently Asked Questions

Pan American Life

Choosing an insurance provider to protect your family or your business is not a decision to be made lightly. Independent rating agencies such as, A.M. Best and Fitch Ratings help to make your choice easier by reviewing the financial strength of insurance companies, taking into account their balance sheet, operating performance, business profile and their ability, in financial terms, to meet their obligations to policyholders.

We’re proud to say that Pan-American Life Insurance Company and its wholly owned subsidiary Pan-American Assurance Company enjoy an A (Excellent) rating from A.M. Best (November 2020) and an A (Strong) rating from Fitch Ratings (February 2021) ; that Mutual Trust Life Insurance Company is rated A (Excellent) by A.M. Best; and that A.M. Best has also given an A (Excellent) rating to Pan-American Casualty Company. These ratings are strong endorsements of the financial strength that enables us to be there when our clients need us the most.

• Pan American Life Insurance Group (PALIG)
• A.M. Best Rating: A (Excellent)
• Financial Size Category: IX ($250M – $500M
• Outlook: Stable
• A.M. Best #: 006893
• NAIC #: 67539
• www.palig.com

US FIRE INSURANCE

Financial Strength View Definition

Rating (Rating Category):	A (Excellent)
Affiliation Code:	P (Pooled)
Outlook (or Implication):	Stable
Action:	Affirmed
Effective Date:	July 14, 2021
Initial Rating Date:	February 14, 1906

Long-Term Issuer Credit View Definition

Rating (Rating Category):	A (Excellent)
Outlook (or Implication):	Stable
Action:	Affirmed
Effective Date:	July 14, 2021
Initial Rating Date:	May 20, 2005

Financial Size Category View Definition

Financial Size Category:	XIV ($1.5 Billion to $2 Billion)
u Denotes Under Review Best’s Rating

Yes.

BRM is a general underwriter, performing all functions relating to medical stop loss coverage, including marketing & sales, underwriting, excess claim adjudication, policy issue, premium administration, commission payment, product development and auditing.

No.

No.

No.

BRM offers specific, aggregate and integrated stop loss insurance.

Yes, for a specific premium load of 9%, no new lasers will be imposed at the next renewal and the specific rate increase at the next renewal will not exceed 50%, provided renewal terms are on a like-to-like basis (contract type, specific deductible, commission level, plan design, enrollment, PPO, etc.). If/when this option is renewed, the 9% premium load again applies and is exclusive of the 50% rate cap.

Yes.

Yes.

Yes, for a premium of $1.00 per employee per month.

Traditional specific and aggregate stop loss is available in 49 states, the District of Columbia, Puerto Rico, the US Virgin Islands.

Specific & Aggregate Stop Loss: 20 eligible employee lives – state-specific minimums apply.

$15,000 (certain state-specific restrictions apply).

Unlimited.

All proposals are issued based on requested due date. Rush requests are accommodated as requested.

Yes. Total paid claims experience and individual participant claims experience are required on all currently self-funded groups, as well as all fully insured groups over 100 employee lives. Fully insured groups of 25 to 100 employee lives must provide total paid claims and individual participant claims experience when available; when unavailable, manual stop loss quotes can be issued. On all cases where individual participant claims experience is unavailable, IMQs are required as a part of the sold-case disclosure and final underwriting process.

Yes, on a limited basis.

Yes. Identical information will generate an identical quote. Information from one producer will not be used to improve terms for other producers.

• A quoted prospect case (new business) that falls below the state-specific minimum life requirement at inception will be declined coverage.
• Any in-force case that falls below the state-specific minimum life requirement at its contract anniversary date is not eligible for renewal.
• Cases must remit premium at actual enrollment levels down to 20 covered employee lives. Any case with enrollment below 20 employee lives must remit premium on a minimum of 20 employee lives. Any premium due above the actual enrollment (up to 20 employee lives) is based on the single rate.
• If the enrollment fluctuates by more than 10% during the plan year, underwriting may request an updated census and reason for the fluctuation.

BRM does not cancel cases at any time during the contract period due to declining enrollment.

Premium may be remitted either gross or net of commission, however, the producer must be appointed by the issuing carrier in the state where the case was sold prior to any commission being released by BRM or withheld by the TPA. All premium checks must be made payable to BRM Specialty Markets, Inc.

Premium may also be paid via ACH transfer. The following timetable applies to premium remittance:

• Premium Due Date: 1st Day of the Month
• Grace Period Ends: 31st Day after Due Date
• Pre-Cancellation Notice Sent to TPA: 32nd Day after Due Date
• Cancellation Notice Sent to TPA & Insured: 45th Day after Due Date

Yes. In the event a case is cancelled, a reinstatement application and instructions are sent to the TPA. Application for reinstatement must be made within 15 days of the date of cancellation notification. The following conditions apply to reinstatement:

• The application for reinstatement must be signed and dated by an authorized representative of the Insured.
• The effective date for reinstatement will be the day following the last day for which premium was paid.
• All overdue and current premium amounts must be submitted with the application for reinstatement.
• The Insured (or its duly authorized representative) must submit monthly loss reports and experience data as requested by BRM.
• BRM’s receipt and deposit of overdue premium in connection with the application for reinstatement does not constitute acceptance of liability on behalf of the insurer. In the event BRM does not approve reinstatement, its sole obligation shall be to refund the unearned premium.
• No coverage is considered reinstated until BRM confirms the reinstatement in writing. Such confirmation or denial will be made within five (5) working days of receipt of the required items.

BRM’s direct dealings with policyholders are limited to the following: A) Cancellation due to nonpayment of premium; B) legal or litigation matters; and C) at the request of the current TPA.

Commission levels from 0% to 15% are available on all stop loss.

Upon request, BRM provides certain information necessary for IRS Form 5500 Schedule A.

• 12/12 Incurred & Paid in 12 Months
• 12/15 Incurred in 12 Months & Paid in 15 Months
• 12/18 Incurred in 12 Months & Paid in 18 Months
• 15/12 Incurred in 15 Months & Paid in 12 Months
• 24/12 Incurred in 24 Months & Paid in 12 Months

BRM will consider other options upon request.

12/12 specific and integrated contracts are generally renewed on a “paid” basis, which offers the greatest protection to the Plan and eliminates adverse selection against the carrier. In the event a 12/12 specific renewal is requested, the Insured must sign an acknowledgement letter that outlines the risk associated with a 12/12 specific or integrated renewal. BRM will renew 12/12 aggregate contracts on a 12/12 basis without an acknowledgement letter.

Traditional specific and aggregate stop loss contracts issued are reimbursement contracts and, as such, require that all claims are properly funded and paid within the time frame required by the applicable contract type (12/12, 12/15, paid, etc.).

Yes, provided the following requirements are met:

• The claim is in compliance with all terms and conditions of the Plan Document and the stop loss contract.
• The Insured has paid all eligible charges up to the specific level.
• All premiums due are paid in accordance with the provisions of the stop loss contract.
• The advance request is received in writing prior to the end of the claim payment period as defined in the stop loss contract.

BRM considers the date the TPA processed the claim as the claim payment date, provided funds sufficient to honor all amounts up to the specific retention are on deposit as of the claim processing date.

No.

Yes, but only in the event of a material change in the risk (e.g., Plan amendment, addition/deletion of subsidiary, significant enrollment change, misrepresentation of underwriting information, etc.).

No. BRM will offer renewal terms on all in-force stop loss coverage regardless of experience. Two events will lead to non-renewal: A) The carrier’s state approval for stop loss coverage is altered or rescinded; or B) case enrollment falls below the state-specific minimum employee lives requirement.

Insureds can select a variety of underwriting methods for addressing known ongoing large claims, including higher specific retentions (lasers), aggregating specifics, and/or premium loads. A “No Laser Renewal / Renewal Increase Maximum” option is also available (see question #13).

Yes, BRM requires a completed Plan Sponsor Disclosure Statement on both new and renewal business. This can be found on our website at www.brmuw.com. The completed Plan Sponsor Disclosure Statement can be submitted up to 60 days prior to the effective date

BRM considers the release date of a check or draft as the claim payment date, provided that funds sufficient to honor the released check or draft are on deposit as of the release date of the check or draft. On specific advances, BRM considers the date the TPA processed the claim as the claim payment date, provided funds sufficient to honor all amounts up to the specific retention are on deposit as of the claim processing date.

Yes.

Certain claim negotiation fees up to 25% of savings, charged by an independent vendor and paid by the Plan, will be considered for reimbursement under the stop loss coverage as a loss adjustment expense, provided the applicable specific and/or aggregate retention is penetrated.

BRM reserves the right to subrogate on behalf of its carrier if the Plan fails to do so and may assist in subrogation matters when requested.

BRM will consider keeping a contract year open in the event payment of a claim must be delayed due to situations such as subrogation, bill negotiation, litigation, etc. BRM must receive a request in writing prior to the end of the contractual claim payment period before any contractual time limits will be waived or extended.

Yes. With specific stop loss, BRM requires notification when total eligible charges on any individual claimant reach 50% of the specific retention or when there is a diagnosis of or treatment for any of the ICD-10 codes listed in the Policyholder Disclosure Statement.

Basic information required to pay a specific claim consists of the following:

• Specific Stop Loss Claim Form
• Enrollment Card (include change forms, Medicare forms, COBRA forms and termination notices)
• Explanation of Benefits (EOBs)
• Itemized Bills
• File Documentation (include correspondence, coordination of benefits forms, subrogation forms, etc.)
• Reasonable & Customary Calculations (for all surgical, anesthesia and assistant surgery procedures)
• Claim Check Copies (or other claim payment verification, subject to approval)

Basic information required to pay an aggregate claim consists of the following:

• Aggregate Stop Loss Claim Form
• Report(s) Listing:
  • Name of Employee and Claimant
  • Incurred Date and Amount of Charge
  • Amount, Date and Check Number of Each Payment
  • Type of Service Rendered or Supply Provided
• Funding Records
• Refund/Void Report
• Specific Analysis Report
• Itemized Prescription Drug Card Invoices
• Eligibility Report Listing:
  • Name
  • Single/Family Status
  • Type of Coverage (medical, dental, PDC, life, etc.)
  • Effective, Change, Termination Dates
• Report Listing Out-of-Contract Payments

Typically, BRM performs a “desk audit” by reviewing the required aggregate claim information on all aggregate claims up to $100,000. On aggregate claims in excess of $100,000 an on-site audit is generally required, to be performed either by BRM or an independent claim audit firm. BRM reserves the right to perform an on-site audit on any aggregate claim, regardless of size.

BRM will issue the stop loss contract in either the name of the employer or the Plan.

The following information is required prior to issuing the stop loss contract:

• Request for Coverage Form
• Signed Application (acceptable by email)
• Specific and Aggregate Premium Due
• Signed Plan Document
• Inception Census
• Signed Plan Sponsor Disclosure Statements

Yes, all Plan Documents must include acceptable definitions and/or provisions relating to the following areas:

• Coordination of Benefits
• Experimental Procedures
• Medical Necessity
• Reasonable & Customary Charges
• Subrogation
• Worker’s Compensation

Further, Plan Documents must not include any references to the stop loss carrier.