Summit Re uses a proprietary coverage analysis tool, called InSight, to give CEOs and CFOs the quantitative decision-making data they need to make informed reinsurance decisions. InSight is designed to ensure that you obtain the most value out of your reinsurance coverage. Please contact your Summit Re regional vice president for a personalized demonstration of this tool which will allow your plan a better understanding of how to structure coverage to ensure its effectiveness.
This top ten list of coverage features that can limit a health plan's reinsurance recoveries is based on our experience in managed care reinsurance and reflected in InSight, our coverage analysis tool.
- Limited coverage for high-cost inpatient tertiary care referrals. Where are the high costs-per-day problems: in network or out-of-network?
- Artificial per diems, case rates or fee schedules that do not reflect actual plan costs.
- Reinsurance deductibles chosen at a level too low, producing too many reinsurance claims with the reinsurers margin built in.
- Inpatient per day coverage limits not mirroring plan underlying average daily costs for high cost claims.
- Purchasing reinsurance on budgetable claims such as professional services versus hospital inpatient-only coverage.
- Reinsuring chronic cases. Again, the reinsurer will build in its margin on a budgetable claim.
- Covering outpatient facility benefits which may have limited value for catastrophic reinsurance.
- Variable coinsurance and its potential for lowering coverage on high-cost out-of-network hospital confinements. Alternatively, coinsurance may vary by inpatient costs per day.
- Reinsurer definitions If the treaty has separate definitions for acute care, medically necessary or experimental treatments, the reinsurer may exclude certain claims that you have paid because of its ability to use its own definitions that may not match your health plans certificate of coverage.
- Alternate funding programs These complex programs are another way for a reinsurer to protect its downside risk without giving the plan real risk protection.
To avoid reinsurance coverage errors, contact us today to arrange for a demonstration of the coverage analysis tool. Current clients have a coverage analysis done as a routine part of our annual renewal process.
If you use United Resources Network (URN) through Summit Re to manage your transplant cases, the access fee can be submitted and considered as a claims expense if the claim exceeds the annual retention. Also, URN network claims will be considered at a higher coinsurance level and the average daily maximum limitation (ADM) will not be applied to case rates (Base Payment Rate or BPR). Should a URN arrangement go into an outlier arrangement, the BPR, or case rate portion, is still not subject to the ADM. Only the outlier portion will be subject to the ADM. This provides for higher reinsurance recoveries to the plan, and it is handled via claim administration guidelines rather than by policy amendment.
We believe in transparency to the purchaser when it comes to compensation. One can draw the analogy of life insurance financial consultants. They should generally be receiving compensation through fees or commissions, but not both. We earn our fees through our contractual relationship with ERC. We do not load in (and never have) any compensation for transplant networks or other managed care services offered as part of the reinsurance coverage claim reimbursement. You may inquire if other managing underwriters have any such hidden managed care service fees or if brokers have any contingent commission arrangements on your funds. You have the right to know because it's your money!
Brokers, managing underwriters, and reinsurers are subject to a wide variety of licensing and compliance requirements. Summit Re believes in playing by the rules and a level playing field. To that end, we have obtained a wide variety of licenses to meet specific state requirements (e.g., general agency, reinsurance intermediary broker or manager, managing underwriter, general business corporation). Can you imagine selling against an unlicensed HMO? We are aware that some of our competitors have taken shortcuts in these regards on the employer stop-loss and/or HMO reinsurance business. You might ask the sales representatives of other carriers or managing underwriters if they have all the required licenses. You should have them explain how they are licensed and show you a copy. Its only good business to deal with companies which are properly compliant, especially in today's environment of close scrutiny.
Summit Re and GE Insurance Solutions announced the hiring of three new managed healthcare reinsurance personnel in 2004. We are committed to hiring the personnel needed to expand our presence in the managed healthcare reinsurance marketplace and provide our customers unmatched service. We remain dedicated to this market and customers we serve. The addition of the following talents enhances an already strong team. John Broyles joined Summit Re on January 19. John formerly worked for Risk Based Solutions as a principal and founder. He is excited to be part of the Summit Re and ERC managed care reinsurance growth strategy. John will sell to and service health plans in selected regions as Regional Vice President, Sales.
Larry Jackson joined Summit Re on July 19. Larry is a former Lincoln Re employee with 18 years of experience in the healthcare actuarial arena, specifically employer stop loss and health plan reinsurance. He will underwrite managed healthcare and employer stop loss accounts and assist in the maintenance of pricing programs and managed care network analysis.
Deborah Stubbs joined Summit Re on September 7 as a managed care specialist. She is responsible for providing consultative case management services to our clients, assisting our underwriters in the assessment of potential catastrophic claims and leading the managed care vendor selection process. Debbie also meets with clients and prospects to explain our value-added managed care services. Debbie was most recently the Manager - Training and Education for the utilization management department of Kaiser Permanente of the Mid-Atlantic States.
Are you contacted relentlessly by reinsurance brokers? We believe in marketing directly to our customers, rather than through a middleman. The advantages of direct marketing include:
- Direct contact with you enables us to do our own risk analysis to best match excess coverage to a plans needs and objectives. This direct interaction is particularly important due to complex product structures and your evolving needs.
- Field underwriting gives us a thorough understanding of the risk that you are assuming, rather than relying on a middleman for critical information.
- Understanding your unique strategies and having direct contact with your management allows us to match other products and services to your plans needs.
- Expense management is needed for long-term survival in a competitive managed care market. A typical broker commission adds 10 percent to premium costs.
Summit Re/GE Insurance Solutions is one of four major providers of HMO excess loss coverage, defined as carriers with over 10% market share each. Two of the four top reinsurers market directly. This means that if you use a broker and don't also access the direct markets like Summit Re independently of your broker, you will miss quotes from half of the major reinsurers. Certain brokers may even be unable to access some broker markets because they have no relationship with the carrier. This reduces the broker's reach even further.
If you do use a broker, nothing stops you from accessing the expertise of Summit Re, as well. If you give us a chance to help you, you won't be disappointed.
In September General Electric (NYSE: GE) announced it will unify the branding of its reinsurance and commercial insurance products and services as GE Insurance Solutions. "The name change is significant, yet it's the first step toward building a powerful brand, said Ron Pressman," Chairman, President and CEO. "Our brand is our promise to our customers that they will get world-leading risk expertise from dedicated people who build strong relationships by delivering unsurpassed customer service."
Pressman continued: "The foundations of our brand are in place. We've retooled the organization by our strong customer relationships and rededicating ourselves to delivering the kinds of solutions our customers need to succeed in their markets. With more than $50 billion in combined assets and $7 billion in statutory capital, this business has never been stronger financially or strategically."
The new brand name replaces Employers GE Re, Frankona Re, Westport Insurance and nearly a dozen other go-to-market names. However, insurance and reinsurance risks will continue to be underwritten by the existing legal entities, whose legal names will not change. GE Global Insurance Holdings is changing its name to GE Insurance Solutions Corporation.
The announcement of the new GE Insurance Solutions brand is part of an overall rebranding at GE, which is dramatically reducing its market-facing entities and names. GE Insurance Solutions is a group of companies that protects people, property and reputations. With more than $50 billion in combined assets, GE Insurance Solutions is one of the leading providers of commercial insurance, reinsurance and risk management services.
The following comments are from a GE Insurance Solutions press release regarding a rating review by A.M. Best. The affirmation of Employers Re's financial strength rating by A.M. Best reflects its excellent risk-adjusted capitalization, improving operating performance and its dominant market presence and distribution capabilities. With two years of improving underwriting results bolstered by asset sales and other capital management improvements, as well as significant third-party aggregate stop loss protection, Employers Re has maintained capital in line with an A (Excellent) rating and has exhibited prospective long-term earnings capability stemming from its well diversified business platform. In addition, over the past two years the company has executed underwriting actions, implemented tighter underwriting controls and has maintained its prominence in the worldwide reinsurance markets through its international distribution capabilities.
GE Insurance Solutions has developed a web-based rating and underwriting program that allows interactive communication between Summit Re and GE Insurance Solutions. Healthcare.com uses a single entry source that helps eliminate errors and yields more efficient underwriting capabilities. Customers benefit from quicker turn-around times on their quotes, as well as more accurate proposals and contracts. *Note: This article was current in 2004, but the URL Healthcare.com now houses another site.