Reinsurance / Stop-Loss

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.

For more information, please contact us here.