Reinsurance Requirements and Effect on Capitation Rates Clause Samples

The "Reinsurance Requirements and Effect on Capitation Rates" clause defines how the presence or absence of reinsurance coverage impacts the calculation of capitation payments in a contract. It typically outlines the minimum reinsurance standards that must be maintained by a party, such as an insurer or provider, and describes how capitation rates may be adjusted if those requirements are not met or if reinsurance terms change. For example, if a provider loses reinsurance coverage or obtains coverage with higher deductibles, the capitation rate paid by the payer may be recalculated to reflect the increased risk. This clause ensures that financial risk is appropriately allocated and that capitation payments remain fair and actuarially sound in light of changing reinsurance arrangements.
Reinsurance Requirements and Effect on Capitation Rates. Ohio Administrative Code requires MCPs contracted with ODM for the MMC program to carry reinsurance for high cost inpatient claims. We have adjusted inpatient expenses in the historical period by the net cost of reinsurance (reinsurance premiums less reinsurance recoveries) as reported in the 2018 annual cost report data. Reinsurance recoveries were based on amounts reported in MCP cost report data.
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Reinsurance Requirements and Effect on Capitation Rates. MyCare MCOPs are required to maintain minimum reinsurance protection as set out in the Ohio Administrative Code. The three-way contract for the Opt-In program outlines specific requirements. We have adjusted expenses in the historical period by the net cost of reinsurance (reinsurance premiums less reinsurance recoveries) as reported by the MCOPs in their 2024 Survey submissions.
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Reinsurance Requirements and Effect on Capitation Rates. MyCare MCOPs are required to maintain minimum reinsurance protection as set out in the Ohio Administrative Code. The 3-way contract for the Opt-In program outlines specific requirements. Opt-Out requirements are consistent with the Opt-In requirements. We have adjusted expenses in the historical period by the net cost of reinsurance (reinsurance premiums less reinsurance recoveries) as reported in the 2019 annual cost report data. Reinsurance recoveries were based on amounts reported in MCOP cost report data. 7 Activities that improve health care quality, ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇▇▇▇▇▇.▇▇▇/cfr/text/45/158.150 8 Activities related to external quality review, ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇▇▇▇▇▇.▇▇▇/cfr/text/42/438.358
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Reinsurance Requirements and Effect on Capitation Rates. MyCare MCOPs are required to maintain minimum reinsurance protection as set out in the Ohio Administrative Code. Refer to the 3-way contract for specific requirements. Opt-Out requirements are consistent with the Opt-In requirements. An adjustment was not made in the rate development process due to the immaterially of the net impact of reinsurance (premium and recoveries).
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Reinsurance Requirements and Effect on Capitation Rates. Ohio Administrative Code requires MCPs contracted with ODM for the MMC program to carry reinsurance for high cost inpatient claims13. We have adjusted inpatient expenses in the historical period by the net cost of reinsurance (reinsurance premiums less reinsurance recoveries) as reported in the 2014 annual cost report data. The aggregate statewide reinsurance loss ratio for MCPs in 2014 was approximately 79% (reinsurance recoveries / reinsurance premiums). A statewide estimated reinsurance premium by rate cell was developed by taking statewide reinsurance recoveries for each rate cell and dividing by the 79% loss ratio. The statewide rate cell reinsurance premium estimates were further adjusted based on estimated regional reinsurance loss ratios. Reinsurance recoveries were based on amounts reported in MCP cost report data. While we have not changed the aggregate amount of MMC reinsurance premiums reported, we believe these adjustments allocate the reinsurance premium on a more actuarial sound basis at the rate cell level.
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