by Maria K. Iarossi
Manager, Reinsurance Operations
Group Insurance Services, Inc.

Group Insurance Services, Inc. (GIS), an affiliated company of BlueCross BlueShield of Tennessee (BCBST), provides ancillary products to BCBST customers. One of the key services provided by GIS is stop-loss coverage for self-insured employers. However, GIS does not provide the stop-loss coverage directly, instead it develops relationships with strong stop-loss vendors to provide comprehensive, cost-effective coverage to its employers.

by Ana Bischoff
Marketing Director
Evergreen Re

By 2010, the severity and frequency of catastrophic healthcare claims are expected to grow to unprecedented levels, according to a recent study commissioned by Evergreen Re, the nation’s largest health plan reinsurance broker.

Rapidly growing health plans and insurers, including start up plans and plans with new product offerings or service area expansion, are turning to quota share reinsurance to help spread the risk and meet or improve their surplus positions. This risk transfer insurance strategy not only provides much needed capital relief, it also comes with an army of actuaries and other experts working with plans with whom they have partnered to ensure their future success.

by Brian Featherstone
Vice President and Chief Actuary
HM Insurance Group

When pricing employer stop loss, the first-dollar claims savings reports generated by payors on behalf of their managed care partners may not be enough – digging a little deeper can be well worth the effort. In fact, when evaluating PPO networks, relying on first-dollar claims savings reports can be very misleading. To help ensure the best price, factors such as the stop loss deductible and the provider reimbursement schedules, including outlier provisions, must be considered.

Coalition America, Inc. (CAI) is pleased to announce the addition of four PPO networks further strengthening its position as a leader in cost containment programs for medical and dental claims. In an effort to continually improve client savings performance, CAI is adding four new PPO networks while also growing its direct provider contracts to over 120,000.

CAI’s unique direct provider agreements represent negotiated contracts between CAI and providers of medical services that have not historically participated in PPO programs. "CAI’s national and well recognized client base of over 200 payors allows CAI to work collaboratively with payors to yield increased savings; with providers to provide consistency in their reimbursement; and with health plan users to reduce their costs," says Tina Ellex, chief operating officer for CAI.  "We have created an unparalleled offering since these provider contracts are unique to CAI and unlikely part of any other PPO program that the payors utilize today.  CAI continues to gain market share as a result of our ability to impact both hit rate and savings rate for our clients."