Peace of Mind for HMOs, ACOs, and Managed Care Organizations
Health care reform, economic conditions, and other variables can all threaten a managed care organization’s stability. Through our HMO Reinsurance, Berkley Accident and Health can help shield organizations so they can weather these changes. Clients receive protection from the risk of a single, high-cost patient or multiple patients, as well as our:
1. Expert analysis
Working closely with our actuarial, medical, and financial experts, we can help clients identify the right balance of protection. First, we conduct an in-depth claims experience review, followed by a review of provider contracts, as well as their cost and utilization data. From this, we determine the best mix of reinsurance and risk retention for custom coverage that keeps risks — and costs — under control.
2. Financial backing to handle even the largest claims
Berkley Life and Health Insurance Company is rated A+ (Superior) by A.M. Best and is a member of the prestigious Ward’s 50 list of top-performing insurers for safety and consistency.
Program Features
- Specific coverage: deductibles from $50,000 to $2,000,000
- Coinsurance: up to 90%
- Limits: up to $10,000,000 per member per year
- Flexible minimum premiums available for start-ups
- Alternative funding arrangements
- Berkley Edge: access to money-saving clinical medical services and specialty vendors
- Fixed fee transplant incentives
- Insolvency coverage
Availability
- Commercial HMO, POS, PPO, and Exchange memberships
- Medicare and Medicare Special Needs Program
- Medicare/Medicaid Dual Eligibles
- Medicaid TANF, SSI, and SPD
- Healthy Families Program
- Child and Family Health Plus Program
Coverage Options
- Inpatient and/or Outpatient Hospital
- Skilled Nursing, Extended Care, and Rehabilitation Facilities
- Long Term Acute Care Facilities
- Home Health Care
- Professional Care
- Pharmaceuticals
- Ambulance
- Durable Medical Equipment