HMO Reinsurance, also called HMO Excess, is a reinsurance policy that an HMO can purchase to share risk with an outside reinsurance company. The most common form of HMO Reinsurance is Stop Loss Reinsurance. In this case the HMO buys coverage from a reinsurer that triggers the coverage at a defined dollar amount or stop loss deductible on a per patient basis.

Example: The HMO wants the HMO Reinsurance to trigger at $100,000. When the HMO has a member whose claims reaches $100,000, they keep paying the claim, but every dollar above the $100,000 stop loss deductible is now eligible for reimbursement by their HMO Reinsurance Company. The HMO submits its claims to the HMO Reinsurer after it pays the claims, and the HMO Reinsurer reimburses the expense to the HMO.

Insolvence Reinsurance-
A HMO can buy this coverage to protect patients from a HMO’s insolvency. The reinsurer will pay the claims on any member who is impatient at the time of the HMO’s bankruptcy.

HCP National is an HMO Reinsurance Insurance Company or licensed Reinsurance Intermediary. We specialize in all forms of Provider Stop Loss, HMO Reinsurance, Stop Loss Reinsurance, Quota Share Reinsurance, Fronting Paper, Captive Reinsurance and Provider Stop Loss.