HMO Reinsurance

We offer comprehensive and competitive HMO reinsurance solutions through our relationship with Summit Reinsurance Services, Inc. (Summit Re), a reinsurance intermediary broker. The combination of Summit Re’s broad managed care expertise and our financial security provide you and your clients with the creative, long-term solutions you seek. Collectively, our experienced team understands the unpredictability of your business as an HMO.

With us, you also have the advantage of our portfolio of managed care services. Through our HMO reinsurance coverage, you will have access to the managed care vendor programs that include expert doctors and surgeons, facilities and other managed care resources. Together with Summit Re we have one goal — to help you maximize your potential for delivering premium services to your participants while still managing the impact of claims borne out of catastrophic losses.

Coverage options and other services

  • Reinsurance for unpredictable catastrophic medical conditions within the covered membership
  • Limited coverage for continuation of benefits in the event of insolvency
  • Access to out-of-area individual health conversion policy for HMO commercial members who move outside your service area
  • Access to national managed care vendors to help manage catastrophic risk


Product specifications

  • Each HMO excess reinsurance account is unique and given individualized attention. However, generally:

Minimum specific retention

You, as the insured or reinsured party, retain the first portion of the risk per Member per Agreement Period.

 

Hospital*

Physician

Commercial USD 50,000 USD 15,000
Medicare USD 75,000 USD 15,000
Medicaid USD 50,000 USD 15,000



Excess retention

  • You also retain a portion of the risk, after meeting the specific retention
  • If you wish to reduce your reinsurance costs further, claims exceeding the specific retention may be reimbursed at a higher percentage if in-network contracted or national centers of excellence network hospitals are utilized for high-cost catastrophic cases


Agreement/policy limits

  • Annual/lifetime maximums: USD 2 million per member per year; USD 2 million per member lifetime.
  • Continuation of benefits in event of insolvency may be available subject to a maximum.


Special HMO excess treaty features

  • Hospital average daily limits per continuous hospital stay (eg, USD 4,000, USD 3,000) are applied to contracted and non-contracted claims
  • Limitations and exclusions are set forth in Agreement terms


For more information

HMO reinsurance is available via:

  • Our team's exclusive, new business production source
  • Summit Reinsurance Services, Inc. (Summit Re) of Fort Wayne, Indiana
  • Brokers can bring HMO opportunities to Summit Re on a consulting fee basis

 

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HMO Reinsurance

Contact Information:

For more information, find the Summit Reinsurance representative for your state.