Reinsurance Requirements and Effect on Capitation Rates Sample Clauses

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. Refer to the 3-way contract for specific requirements.
Sample 1
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, xxxxx://xxx.xxx.xxxxxxx.xxx/cfr/text/45/158.150 8 Activities related to external quality review, xxxxx://xxx.xxx.xxxxxxx.xxx/cfr/text/42/438.358
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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 claims.13 We have adjusted inpatient expenses in the historical period by the net cost of reinsurance (reinsurance premiums less reinsurance recoveries) as reported in the 2015 annual cost report data. The aggregate statewide reinsurance loss ratio for MCPs in 2015 was approximately 86% (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 86% 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.
Sample 1
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.
Sample 1

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  • Insurance Requirements Vendor agrees to maintain the following minimum insurance requirements for the duration of this Agreement. All policies held by Vendor to adhere to this term shall be written by a carrier with a financial size category of VII and at least a rating of “A‐” by A.M. Best Key Rating Guide. The coverages and limits are to be considered minimum requirements and in no way limit the liability of the Vendor(s). Any immunity available to TIPS or TIPS Members shall not be used as a defense by the contractor's insurance policy. Only deductibles applicable to property damage are acceptable, unless proof of retention funds to cover said deductibles is provided. "Claims made" policies will not be accepted. Vendor’s required minimum coverage shall not be suspended, voided, cancelled, non‐renewed or reduced in coverage or in limits unless replaced by a policy that provides the minimum required coverage except after thirty (30) days prior written notice by certified mail, return receipt requested has been given to TIPS or the TIPS Member if a project or pending delivery of an order is ongoing. Upon request, certified copies of all insurance policies shall be furnished to the TIPS or the TIPS Member. Vendor agrees that when Vendor or its subcontractors are liable for any damages or claims, Vendor’s policy, shall be primary over any other valid and collectible insurance carried by the Member or TIPS. General Liability: $1,000,000 each Occurrence/Aggregate Automobile Liability: $300,000 Includes owned, hired & non‐owned Workers' Compensation: Statutory limits for the jurisdiction in which the Vendor performs under this Agreement. If Vendor performs in multiple jurisdictions, Vendor shall maintain the statutory limits for the jurisdiction with the greatest dollar policy limit requirement. Umbrella Liability: $1,000,000 each Occurrence/Aggregate

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