Incurred claims definition

Incurred claims means total claims paid during the experience period, adjusted for the change in claim reserve. (7-1-93)

Split View

AI-Powered Contracts

Draft, Review & Redline at the Speed of AI

Get StartedSchedule a Demo

Incurred claims means claims paid during the experience period plus claim reserve at the end of the experience period minus claim reserve at the beginning of the experience period.

Incurred claims means claims which occur during a Commission year including claims reported or paid during a later period. The exact definition of “incurred claims” or any similar term is the definition used in the excess insurance or reinsurance policy purchased by the Commission.

Examples of Incurred claims in a sentence

• Those expenses for administrative services that are not: Incurred claims (as defined in paragraph (e)(2) of 42 C.F.R. § 438.8); expenditures on activities that improve health care quality (as defined in paragraph (e)(3) of 42 C.F.R. § 438.8); or licensing and regulatory fees, or Federal and State taxes (as defined in paragraph (f)(2) of 42 C.F.R. § 438.8).

• Those expenses for administrative services that are not: Incurred claims (as defined in paragraph (e)(2) of 42 C.F.R. §438.8); expenditures on activities that improve health care quality (as defined in paragraph (e)(3) of 42 C.F.R. §438.8); or licensing and regulatory fees, or Federal and State taxes (as defined in paragraph (f)(2) of 42 C.F.R. §438.8).

• Note: Incurred claims for capitated payments to third-party subcontracted vendors, should reflect all adjustments as required in Section I.

• Those adjustments, and other considerations, include the following items: • Program changes in the historical base time period (CY 2004-CY 2005), • Incurred claims estimates based on review of claims lag triangles, and • Other actuarially appropriate adjustments, as needed, to reflect such things as incomplete reporting or other known data issues.

• Incurred claims are as defined in 42 CFR § 438.8. Also known as the Arkansas Independent Assessment (ARIA).

More Definitions of Incurred claims

Incurred claims means claims, which occur during a Fund year, including claims paid during a later period. The exact definition of "Incurred Claims" or any similar term is the definition used in the excess insurance policy purchased by the Fund.

Incurred claims means a Liability related to services or benefits provided under a Benefit Plan, and shall be deemed to be incurred: (a) with respect to medical, dental, vision, and prescription drug benefits, upon the rendering of services giving rise to such Liability; (b) with respect to death benefits, life insurance, accidental death and dismemberment insurance, and business travel accident insurance, upon the occurrence of the event giving rise to such Liability; (c) with respect to disability benefits, upon the date of disability, as determined by the disability benefit insurance carrier or claim administrator, giving rise to such Liability; (d) with respect to a period of continuous hospitalization, upon the date of admission to the hospital; and (e) with respect to tuition reimbursement or adoption assistance, upon completion of the requirements for such reimbursement or assistance, whichever is applicable.

Incurred claims means "claims" paid during the applicable period plus the "claim reserves" as of the end of the applicable period minus the "claim reserves" as of the beginning of the applicable period. Alternatively, for the pur- pose of providing monthly data or trend analysis, "incurred claims" may be defined as the current best estimate of the "claims" for services provided during the applicable period.

Incurred claims means all medical, indemnity, legal, investigative, and other related expenses (including all allocated loss adjustment expenses) on all reported claims, the sum of both paid expenses and open claims reserves net of any subrogation or excess insurance receivable (in the reasonable discretion of the Group’s administrator), and expressly excluding incurred but not reported claims for the fund year.

Incurred claims means claims for health insurance coverage on a direct basis incurred during the applicable plan year, plus unpaid claim reserves associated with claims incurred during the applicable plan year, plus the change in contract reserves, plus the claims-related portion of reserves for contingent benefits and lawsuits, plus any experience rating refunds paid or received, and reserves for experience rating refunds. This definition is consistent with the statutory accounting definition contained in the then current NAIC Accounting Practices and Procedures Manual and the definition in Appendix C derived from the NAIC Supplemental Health Care Exhibit as adopted by the National Association of Insurance Commissioners on August 17, 2010. If there are any group conversion charges for a health plan, the conversion charges should be subtracted from the incurred claims for the aggregation that includes the conversion policies and this same amount should be added to the incurred claims for the aggregation that provides coverage that is intended to be replaced by the conversion policies. Additionally, if the issuer transfers portions of earned premium associated with group conversion privileges between Group and Individual lines of business in its Annual Statement accounting, these amounts should be added to or subtracted from incurred claims.

Incurred claims means claims for payment of health care services that are provided to Members pursuant to the Plan with a date of service within the period of time this Agreement is in effect.

Incurred claims means the total claims an insurer pays during an experience period, adjusted for the change in the claim reserves.