Provider Excess Loss
Healthcare reform is changing the risk landscape for all types of medical providers. Some of the factors increasing the risk profile of these providers include increasingly sophisticated and expensive technology, medical data security, and the growing prevalence of capitation or other risk arrangements with HMOs, ACOs, and government programs.
TMS Re PEL programs provide protection to hospitals, physician groups, and other medical providers that have entered into all types of risk-bearing contracts. Our team understands the complexity of PEL risk and can clearly assess your total risk exposure. We tailor coverage for each individual medical provider’s need, which can be based upon proprietary fee schedules, Medicare fee schedules, state Medicaid fee schedules, per diems or percentage of charges. We can help manage and limit costs from members’ catastrophic illnesses, accidents, and other unanticipated losses.
Among the plan policy options we provide:
Specific only coverage
Aggregate only coverage
Deductibles that meet CMS guidelines
Aggregating Specific Deductible plans
Claims (Retro) Corridor plans
Experience Refund / Profit Commissions
31 day carry-forward
31 day run-in provisions
Ability to combine multiple HMO contracts into a single policy
Onsite account installation.
A reinsurance leader with A+ ratings by both A.M. Best and S&P Global Ratings, seasoned underwriters, and substantial reserves
Our partnership with Everest Re also allows us to underwrite HMO Reinsurance and Medical Excess of Loss Reinsurance.
All products and services are subject to state and underwriting requirements. For complete information, please contact us at 786.747.0826.