Protection purchased by self-funded buyers against the risk of large losses or a severe adverse claim experience
This is a type of reinsurance which can be taken out by a health plan or self-funded employer plan. The plan can be written to cover excess losses over a specified amount either on a specific or individual basis, or on a total basis for the plan over a period of time such as one year.
Insurance coverage that enables sponsors of self-insured group health care plans to place a dollar limit on their liability for paying claims.
(also referred to as reinsurance) – An alternative or supplement to risk sharing for MCOs. In a stop-loss or reinsurance arrangement, the Medicaid program or third-party insurer offers to cover any expenditures that a plan must make over some threshold for an individual in a specified time period. For example, the state might offer to cover all expenditures over $100,000 for any individual whose costs exceed $100,000 for the year.
A type of insurance coverage that enables provider organizations or self-funded groups to place a dollar limit on their liability for paying claims and requires the insurer issuing the insurance to reimburse the insured organization for claims paid in excess of a specified yearly maximum.
Protection purchased by self-insured and some managed care arrangements against the risk of large losses or severe adverse claims experience.
(see also Reinsurance): Insurance coverage purchased by a payer to provide protection from losses that result when claims exceed prospective payments; used when risk is difficult to predict or manage. Such insurance often covers claims for any enrollee that exceed a predetermined deductible, such as $25,000 or $50,000, or situations in which total claims exceed a predetermined level, such as 125% of the amount expected in an average year.
Coverage purchased by self-funded medical plans or plan sponsors to cover claims over a certain amount, on an individual or aggregate basis. The coverage protects the employer in most situations and does not make the medical plan itself insured for purposes of ERISA. Also called “excess insurance” or “reinsurance”.
Insuring against a specified level of financial risk with a third party.
Insurance purchased by employers that self-insure group health insurance plans so that they can place a maximum dollar limit on their liability for paying claims.
A type of insurance that managed care organizations purchase to protect against excessive costs associated with a few high-cost beneficiaries.