Description: To inform and educate stakeholders for health plans and insurers on novel ways to optimize reinsurance structures to meet capital related goals and boost RBC and liquidity ratios. In lieu of traditional market-based financial instruments involving equity and/or debt, a quota share transaction can be used with potentially far more attractive terms and achieving essentially the same result.

Description: Feature article discussing the impact of health care reform on the direct insurance market and the reinsurance market.

Description: This year’s Survey, its sixth year, further reflects the impact of health care reform and the resulting prevalence of unlimited lifetime maximums on stop loss coverage. Of surveyed plans, 88% report such coverage –a steep increase from 13% in 2010. About half pair an unlimited lifetime with an interim annual maximum of $5 million or less. Premiums continue to rise (to no surprise)and are 60% to 70% higher than levels reported in our initial Survey in 2007. The primary focus of the Survey, current premium rates, is shown in the following graphs and tables.

Description: The impact of benefit design on the cost of Aggregate Stop-Loss Coverage. Issue No. 42.

Description: This article attempts to make a modest contribution to the dialogue on the potential and risks associated with novel treatments such as cell & gene therapies. With a fast-expanding roster of what are believed to be one-time treatments at ever increasing price points aimed at curing a wider swatch of the population, they are as much a source of relief for patients stuck in medical limbo, as they are a source of anxiety for payers.

Description: Excess Reinsurance is a coverage purchased by insurance carriers to limit loss in a year from any one claim. This article addresses the issues when purchasing medical excess reinsurance on a medical portfolio. The most important consideration in the reinsurance purchasing decision is determining the risk objectives of the organization. The proper risk analysis by the carrier or in conjunction with its reinsurer will address the following questions: What is predictable risk versus unpredictable risk?

Description: LEARN is an offering to regulators about reinsurance. This article summarizes a session held for Brazilian health regulators in the fall of 2022.

Description: This article enumerates many important considerations for a managing general underwriter(MGU) desiring to contract with an insurance carrier to issue and service provider excess of loss policies covering catastrophic medical risks assumed by accountable care organizations (ACOs).

Description: Feature article focuses on the regulators who determine risk-based capital or RBC standards applicable to health plans.

Description: Over the years I have come to believe that the nature vs nurture debate is fundamentally flawed, in that it tends to exclude an increasingly important third influence: culture.