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NY Surcharge & Stop Loss Carrier Question

Guest Phil C

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Guest Phil C

Self Insured client changed TPAs and stop loss carriers. The prior stop loss contract was on a 12/15 basis- incurred in 12 months and paid in 15. Here's the issue:

Claim was incurred in the contract period and paid in the 15th month. So far no problem. However, the NY Surcharge for the claim was paid in the beginning of the 16th month as required by NY.

I've been told by several TPAs that the NY Surcharge is treated as having the same "paid" date as the claim it is attached to, not the actual date paid to NY.

The stop loss carrier is treating this as a totally separate event and denying the surcharge claiming it was "paid" outside the contract window. What is common practice on the street as I am getting two different versions?



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