REINSURANCE REQUIREMENTS. Pursuant to the provisions of OAC rule 5101:3-26-09 (C), each MCP must carry reinsurance coverage from a licensed commercial carrier to protect against inpatient-related medical expenses incurred by Medicaid members. Appendix J The annual deductible or retention amount for such insurance must be specified in the reinsurance agreement and must not exceed $75,000.00, except as provided below. Except for transplant services, and as provided below, this reinsurance must cover, at a minimum, 80% of inpatient costs incurred by one member in one year, in excess of $75,000.00. For transplant services, the reinsurance must cover, at a minimum, 50% of transplant related costs incurred by one member in one year, in excess of $75,000.00. An MCP may request a higher deductible amount and/or that the reinsurance cover less than 80% of inpatient costs in excess of the deductible amount. If the MCP does not have more than 75,000 members in Ohio, but does have more than 75,000 members between Ohio and other states, ODJFS may consider alternate reinsurance arrangements. However, depending on the corporate structures of the Medicaid MCP, other forms of security may be required in addition to reinsurance. These other security tools may include parental guarantees, letters of credit, or performance bonds. In determining whether or not the request will be approved, the ODJFS may consider any or all of the following:
a. whether the MCP has sufficient reserves available to pay unexpected claims;
b. the MCP’s history in complying with financial indicators 2.a., 2.b., and 2.c., as specified in this Appendix;
c. the number of members covered by the MCP;
d. how long the MCP has been covering Medicaid or other members on a full risk basis;
e. risk based capital ratio of 2.5 or higher calculated from the last annual ODI financial statement;
f. graph/chart showing the claims history for reinsurance above the previously approved deductible from the last calendar year. The MCP has been approved to have a reinsurance policy with a deductible amount of $150,000 that covers 80% of inpatient costs in excess of the deductible amount for non-transplant services. Penalty for noncompliance: If it is determined that an MCP failed to have reinsurance coverage, that an MCP’s deductible exceeds $75,000.00 without approval from ODJFS, or that the MCP’s reinsurance for non-transplant services covers less than 80% of inpatient costs in excess of the deductible incurred by one member for one year without...
REINSURANCE REQUIREMENTS. 68 3.8 CHANGE IN SCOPE OF WORK............................................................................. 69 3.9
REINSURANCE REQUIREMENTS. The MCO must purchase reinsurance from a commercial reinsurer and must establish reinsurance agreerments meeting the requirements listed below. These agreements must be reviewed and approved by the State prior to their effective date. - The attachment point must be equal to or less than $75,000. - Reinsurance agreements must transfer risk from the ceding company to the reinsurer. - The reinsurer's payment to the ceding company must 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 MCO must follow the National Association of Insurance Commissioners' (NAIC) Reinsurance Accounting Standards and document its compliance with NAIC. - Subcontractors' reinsurance coverage requirements must be clearly defined in the reinsurance agreement. - If subcontractors do not obtain reinsurance on their own, the MCOs should be required to forward appropriate recoveries from stop-loss coverage to applicable subcontractors. - MCOs must receive reinsurance coverage of at least $2,000,000/member/year. - If the MCO elects to self-insure, it must provide audited financial information on its insurance subsidiary and obtain Xxxxx'x or Standard and Poor's bond and claims-paying ability ratings for its insurance subsidiary. - MCOs must obtain continuation of Coverage (Insolvency Insurance) to cover members who are in an acute care hospital/nursing facility setting until their Section 3.0 Revised July 10, 2003
REINSURANCE REQUIREMENTS. Pursuant to the provisions of OAC rule 5101:3-26-09 (C), each MCP must carry reinsurance coverage from a licensed commercial carrier to protect against inpatient-related medical expenses incurred by Medicaid members. The annual deductible or retention amount for such insurance must be specified in the reinsurance agreement and must not exceed $75,000.00, except as provided below. Except for transplant services, and as provided below, this reinsurance must cover, at a minimum, 80% of inpatient costs incurred by one member in one year, in excess of $75,000.00. For transplant services, the reinsurance must cover, at a minimum, 50% of transplant related costs incurred by one member in one year, in excess of $75,000.00. An MCP may request a higher deductible amount and/or that the reinsurance cover less than 80% of inpatient costs in excess of the deductible amount. In determining whether or not the request will be approved, the ODJFS may consider any or all of the following:
REINSURANCE REQUIREMENTS. All Transport Service Provider (TSP) are expected to have up to date insurance and to provide a copy of their CMR insurance policy or a copy of their insurance certificate as issued by the appropriate insurance company. DS reserves the right to contact carrier insurance to confirm the validity of insurance contract.
REINSURANCE REQUIREMENTS. Pursuant to the provisions of OAC rule 5101:3-26-09 (C), each MCP must carry reinsurance coverage from a licensed commercial carrier to protect against inpatient-related medical expenses incurred by Medicaid members. The annual deductible or retention amount for such insurance must be specified in the reinsurance agreement and must not exceed $75,000.00, except as provided below. Except for transplant services, and as provided below, this reinsurance must cover, at a minimum, 80% of inpatient costs incurred by one member in one year, in excess of $75,000.00.
