HMO Reinsurance Underwriting Parameters
| Hospital / Facility Coverage | |
|---|---|
| Minimum Deductibles: | |
| Commercial | 75,000 |
| Medicare | 75,000 |
| Medicaid | 75,000 |
| Coverage Limits: | |
| Maximum Coinsurance | 0.9 |
| Maximum ADM (Average Daily Maximum) | varies based upon deductible and coverage structure |
| Maximum Limit | $2,000,000 per member per contract period |
| Maximum Policy Period | Twelve Months |
| Standard Run-Out Period | Incurred in 12 Months Paid in 18 months, Reported in 19 months (may be extended on case-by-case basis) |
| Maximum Reimbursement | Lesser of contracted amount, ADM times length of stay, paid amount, or billed amount. |
| Physician / Professional Coverage | |
|---|---|
| Minimum Deductibles: | |
| Commercial | 15,000 |
| Medicare | 15,000 |
| Medicaid | 15,000 |
| Coverage Limits: | |
| Maximum Coinsurance | 0.9 |
| Maximum Reimbursement | 150% of RBRVS (will consider alternate on case-by-case basis) |
| Maximum Limit | $1,000,000 per member per policy period |
| Maximum Policy Period | Twelve Months |
| Standard Run-Out Period | Incurred in 12 Months Paid in 18 months, Reported in 19 months (may be extended on case-by-case basis) |
Provider Excess of Loss Insurance Underwriting Parameters
| Hospital / Facility Coverage | |
|---|---|
| Minimum Deductibles: | |
| Commercial | 50,000 |
| Medicare | 50,000 |
| Medicaid | 50,000 |
| Coverage Limits: | |
| Maximum Coinsurance | 0.9 |
| Maximum ADM (Average Daily Maximum) | varies based upon deductible and coverage structure |
| Maximum Limit | $1,000,000 per member per contract period |
| Maximum Policy Period | Twelve Months |
| Standard Run-Out Period | Incurred in 12 Months Paid in 18 months, Reported in 19 months (may be extended on case-by-case basis) |
| Maximum Reimbursement | Lesser of % of Billed Charges or ADM times length of stay. Medicaid limited to Medicaid DRG's for specified area. |
| Minimum Premium | $50,000 per policy period |
| Physician / Professional Coverage | |
|---|---|
| Minimum Deductibles: | |
| Commercial | 15000 |
| Medicare | 15000 |
| Medicaid | 15000 |
| Coverage Limits: | |
| Maximum Coinsurance | 0.9 |
| Maximum Reimbursement | 150% of RBRVS (will consider alternate on case-by-case basis) |
| Maximum Limit | $1,000,000 per member per policy period |
| Maximum Policy Period | Twelve Months |
| Standard Run-Out Period | Incurred in 12 Months Paid in 18 months, Reported in 19 months (may be extended on case-by-case basis) |
| Minimum Premium | $50,000 per policy period |
