Can the amount of claims reimbursed by a stop-loss insurer be submitted for credit towards the $15,000 cost threshold or reimbursement?
Provided all applicable program criteria are met, the fact that a stop-loss insurer reimbursed the health insurance issuer or employment-based plan for some or all costs of a claim, does not prohibit the sponsor from submitting that claim to HHS for credit toward the $15,000 threshold, or reimbursement. For purposes of submitting the claim to HHS, and for purposes of the amount of program credit or reimbursement that HHS will issue to the sponsor, the amount of reimbursement the stop-loss carrier paid to the plan or insurer is irrelevant.
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