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Reinsurance,
Insurance and Provider Stop Loss.
For more information on the following, please contact:
Victor@mcicgroup.com
Reinsurance,
Insurance and Provider Stop Loss.
Reinsurance,
Insurance and Provider Stop Loss.
PROVIDER STOP LOSS
(click
here for Provider Stop Loss form)
(Click
here for HMO Reinsurance Questionnaire form)
Reinsurance,
Insurance and Provider Stop Loss.
Health care
providers in today's managed care industry are struggling to provide
efficient quality health care. This is easier said than done, it is a true
juggling act to provide appropriate health care services and running a
profitable business. Our managed care industry is all about managing risk,
however there's a fine line between managing risk and providing
appropriate medical care.
Reinsurance,
Insurance and Provider Stop Loss.
Managed care risk
bares two types of financial risks, aggregate and catastrophic risk. In
either case a management groups must control or manage the risk. Aggregate
risk refers to the management of utilization. This refers to those medical
services that may not be very expensive but very costly by volume.
Aggregate risk is primarily managed by adjusting a medical group's
utilization practices. Managed care organizations (HMOs) further manage
the cost factor by contracting and in some cases sub-capitating specialty
services. Catastrophic risk refers to high-end claims encounters such as
transplants, oncology, trauma, etc. Although they can be managed they are
unexpected, these types of claims are actuarially projected.
Reinsurance,
Insurance and Provider Stop Loss.
In an effort to
manage the catastrophic risk for provider groups in managed care,
insurance companies have created a product named Provider Stop Loss
available to protect the financial integrity of managed care providers.
Government regulations (HCFA) require minimum deductible requirements for
provider groups with less
than twenty-five thousand capitated members. As these medical provider
groups contract with HMOs their capitation contracts include a Stop Loss
or Reinsurance component. In most cases, provider groups have the option
to replace Their reinsurance coverage with an independent market.
Generally, purchasing this coverage independently is less costly and there
are premium programs that offer tremendous savings to the provide group.
Reinsurance,
Insurance and Provider Stop Loss.
In considering if
your group is a candidate for this product answer the following:
-
Is the
group at financial risk?
-
Are there
at least 2000 capitated members?
-
Are there
one or multiple HMO contracts?
-
What is the
current premium per member per month for each member for
Commercial, Medicaid, and Medicare?
If your answer to
the above questions are yes, consider contacting MCIC to further discuss
some of your reinsurance options at no cost to you.
Managed Care
expertise is vital when considering carving out your excess risk. Most
marketers for this product are not a true consulting source. Provider Stop
Loss is not a common product, it is designed to adjust and provide
coverage based on the level of risk exposure of each client. For this
reason, your consultant or representative must have extensive knowledge of
managed care contracting. While you want to reduce your current premium,
you do want to increase your risk exposure.
Reinsurance,
Insurance and Provider Stop Loss.
MCIC has worked
with numerous risk baring entities around the country, and has
successfully assisted our clients to achieve considerable savings while
designing a customized insurance program to meet their catastrophic risk
exposure. Let us do the same for your organization and we will prove to
you what a true managed care risk insurance consultant can offer you.
Reinsurance,
Insurance and Provider Stop Loss.
Reinsurance, Insurance and Provider Stop Loss.
For
more information, please contact:
Victor@mcicgroup.com
(click
here for Provider Stop Loss form)
(Click
here for HMO Reinsurance Questionnaire form)
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