Consistent with the requirement included in the RFI that the Stop Loss policy will cover all medical and prescription drug claims paid in accordance with the underlying medical Plan(s), excluding exceptions covered under the Plan (extracontractual claims paid), please confirm that the following specific plan provisions will mirror the underlying Plan documents and administration, including, but not limited to definitions and consistent interpretations of the following: a. Waive AAW; All coverage must be provided on a no loss/no gain basis. Stop loss vendors will be required to cover employees not actively at work but eligible for coverage under the client’s benefit plans. Note that this will include disabled and others not actively at work, unless they can be covered by the current vendor. No covered individual’s claims should be excluded from coverage or receive lesser reimbursement due to the change in insurance carriers. b. The underlying medical Plan will determine how Reasonable and Customary (R&C) is defined. 24. Disabled dependents covered
