HMO Reinsurance

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
  • ccSTAT® Risk Management: 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

Insurance coverage is underwritten by Berkley Life and Health Insurance Company and/or StarNet Insurance Company, both member companies of W. R. Berkley Corporation and both rated A+ (Superior) by A.M. Best. Not all products and services may be available in all jurisdictions, and the coverage provided is subject to the actual terms and conditions of the policies issued. Payment of claims under any insurance policy issued will only be made in full compliance with all United States economic or trade and sanction laws or regulation, including, but not limited to, sanctions, laws and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (“OFAC”).