siia stop-loss legal fund

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We Pledge the Following Financial Support (Only to be billed should litigation be initiated.) Contact Information Name_______________________________________________ Title _______________________________________ Company _______________________________________________________________________________________ Address ________________________________________________________________________________________ Phone_______________________________________________ E-mail _____________________________________ Please Return Completed Form to: SIIA P .O. Box 1237 • Simpsonville, SC 29681 or Email: [email protected] or Fax: 864/962-2483 $50,000 $25,000 $10,000 $5,000 $2,500 $1,000 Other $________ Help SIIA Fight Unlawful Regulation of Stop-Loss Insurance Legal Defense Fund Pledge Form Overview The Self-Insurance Institute of America, Inc. (SIIA) is preparing a litigation strategy in response to anticipated action(s) at the state level to more tightly regulate stop-loss insurance attachment points. SIIA believes that such action(s) will have the effect of restricting the ability of many employers from self-insuring and the association’s legal counsel has concluded that there is a viable ERISA preemption challenge that can be presented in federal court. The particular state law(s) to be challenged will be dictated by future developments and subsequent analysis with regard to the likelihood of success. Financial Support Request SIIA expects that a litigation response will be costly, so it is seeking the financial support of its members and other industry stakeholders at this time in the form of pledges in order to confirm it will have the money necessary to mount a robust legal challenge at least through the trial court level, with the assumption that additional rounds of fund-raising will be required later to take this matter all the way to the U.S. Supreme Court if necessary. The association intends to collect on all pledges if and when it has decided on a specific course of legal action, again based on legislative/regulatory developments in various states. Financial contributions will be made to SIIA’s Legal Defense Fund, which is a segregated account used exclusively to pay for litigation related expenses. For contributions of $25,000 or more, your company will be provided one position on the litigation steering committee, which will be involved with strategy decisions. Questions? Should you have questions regarding this initiative, please contact SIIA Chief Operating Officer Mike Ferguson at 800/851-7789 (office), 864/363-2600 (cell), or via e-mail at [email protected].

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Page 1: SIIA stop-loss legal fund

We Pledge the Following Financial Support(Only to be billed should litigation be initiated.)

Contact InformationName_______________________________________________ Title _______________________________________

Company _______________________________________________________________________________________

Address ________________________________________________________________________________________

Phone_______________________________________________ E-mail _____________________________________

Please Return Completed Form to:SIIA P.O. Box 1237 • Simpsonville, SC 29681 or Email: [email protected] or Fax: 864/962-2483

$50,000

$25,000 $10,000

$5,000 $2,500

$1,000 Other $________

Help SIIA Fight Unlawful Regulation of Stop-Loss Insurance

Legal Defense Fund Pledge Form

Overview The Self-Insurance Institute of America, Inc. (SIIA) is preparing a litigation strategy in response to anticipated action(s) at the state level to more tightly regulate stop-loss insurance attachment points. SIIA believes that such action(s) will have the effect of restricting the ability of many employers from self-insuring and the association’s legal counsel has concluded that there is a viable ERISA preemption challenge that can be presented in federal court. The particular state law(s) to be challenged will be dictated by future developments and subsequent analysis with regard to the likelihood of success.

Financial Support Request SIIA expects that a litigation response will be costly, so it is seeking the financial support of its members and other industry stakeholders at this time in the form of pledges in order to confirm it will have the money necessary to mount a robust legal challenge at least through the trial court level, with the assumption that additional rounds of fund-raising will be required later to take this matter all the way to the U.S. Supreme Court if necessary.

The association intends to collect on all pledges if and when it has decided on a specific course of legal action, again based on legislative/regulatory developments in various states. Financial contributions will be made to SIIA’s Legal Defense Fund, which is a segregated account used exclusively to pay for litigation related expenses. For contributions of $25,000 or more, your company will be provided one position on the litigation steering committee, which will be involved with strategy decisions.

Questions? Should you have questions regarding this initiative, please contact SIIA Chief Operating Officer Mike Ferguson at 800/851-7789 (office), 864/363-2600 (cell), or via e-mail at [email protected].