Net Reinsurance Sample Clauses

Net Reinsurance. Ohio Administrative Code requires MCPs contracted with ODM for the MMC program to carry reinsurance for high cost inpatient claims. We have adjusted inpatient expenses in the historical period by the net cost of reinsurance (reinsurance premiums less reinsurance recoveries) as reported in the CY 2018 annual cost reports. The aggregate statewide reinsurance loss ratio for MCPs in CY 2018 was approximately 85% (reinsurance recoveries / reinsurance premiums). A statewide estimated reinsurance premium by rate cell was developed by taking statewide reinsurance recoveries for each rate cell and dividing by the 85% loss ratio. The statewide rate cell reinsurance premium estimates were further adjusted based on estimated regional reinsurance loss ratios. Reinsurance recoveries were based on amounts reported in MCP cost report data. While we have not changed the aggregate amount of MMC reinsurance premiums reported, we believe these adjustments allocate the reinsurance premium on a more actuarially sound basis at the rate cell level.
Sample 1Sample 2Sample 3See All (13)
AutoNDA by SimpleDocs
Net Reinsurance. Consideration Due to the Reinsurer (Ceding Company) (1) - (2) + (3)
Sample 1Sample 2
Net Reinsurance. The base data was adjusted to reflect net reinsurance expenditures using reinsurance premiums and recoveries based on amounts reported in the SFY 2022 cost reports collected as part of the CY 2024 MCOP Survey process. Pharmacy Rebates The base data was adjusted to reflect pharmacy rebates received by the MCOPs based on amounts reported in the SFY 2022 cost reports collected as part of the CY 2024 MCOP Survey process.
Sample 1Sample 2
Net Reinsurance. The MCO provider agreement requires MCOs contracted with ODM for the MMC program to carry reinsurance for high cost inpatient claims. We adjusted inpatient expenses as part of the base data development using the net cost of reinsurance (reinsurance premiums less reinsurance recoveries) as reported in the CY 2019 annual cost reports. The aggregate statewide reinsurance loss ratio for MCOs in CY 2019 was approximately 78% (reinsurance recoveries / reinsurance premiums). A statewide estimated reinsurance premium by rate cell was developed by taking statewide reinsurance recoveries for each rate cell and dividing by the 78% loss ratio. The statewide rate cell reinsurance premium estimates were further adjusted based on estimated regional reinsurance loss ratios. Reinsurance recoveries were based on amounts reported in MCO cost report data. While we have not changed the aggregate amount of MMC reinsurance premiums reported, we believe these adjustments allocate the reinsurance premium on a more actuarially sound basis at the rate cell level.
Sample 1

Related to Net Reinsurance

  • Reinsurance The Contractor shall purchase reinsurance from a commercial reinsurer and shall establish reinsurance agreements meeting the requirements listed below. The Contractor shall submit new policies, renewals or amendments to OMPP for review and approval at least one hundred and twenty (120) calendar days before becoming effective.  Agreements and Coverage  The attachment point shall be equal to or less than $200,000 and shall apply to all services, unless otherwise approved by OMPP. The Contractor electing to establish commercial reinsurance agreements with an attachment point greater than $200,000 must provide a justification in its proposal or submit justification to OMPP in writing at least one hundred and twenty (120) calendar days prior to the policy renewal date or date of the proposed change. The Contractor must receive approval from OMPP before changing the attachment point.  The Contractor’s co-insurance responsibilities above the attachment point shall be no greater than twenty percent (20%).  Reinsurance agreements shall transfer risk from the Contractor to the reinsurer.  The reinsurer's payment to the Contractor shall depend on and vary directly with the amount and timing of claims settled under the reinsured contract. Contractual features that delay timely reimbursement are not acceptable.  The Contractor shall maintain a plan acceptable to the IDOI commissioner for continuation of benefits in the event of receivership. The Contractor must finance the greater of $1,000,000 or total projected costs as calculated by the form set forth in 760 IAC 1-70-8.  The Contractor shall obtain continuation of coverage insurance (insolvency insurance) to continue plan benefits for members until the end of the period for which premiums have been paid. This coverage shall extend to members in acute care hospitals or nursing facility settings when the Contractor’s insolvency occurs during the member’s inpatient stay. The Contractor shall continue to reimburse for its member’s care under those circumstances (i.e., inpatient stays) until the member is discharged from the acute care setting or nursing facility.  Requirements for Reinsurance Companies  The Contractor shall submit documentation that the reinsurer follows the National Association of Insurance Commissioners' (NAIC) Reinsurance Accounting Standards.  The Contractor shall be required to obtain reinsurance from insurance organizations that have Standard and Poor's claims- paying ability ratings of "AA" or higher and a Xxxxx’x bond rating of “A1” or higher, unless otherwise approved by OMPP.  Subcontractors  Subcontractors’ reinsurance coverage requirements must be clearly defined in the reinsurance agreement.  Subcontractors should be encouraged to obtain their own stop-loss coverage with the above-mentioned terms.  If subcontractors do not obtain reinsurance on their own, the Contractor is required to forward appropriate recoveries from stop- loss coverage to applicable subcontractors.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!