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<br />j <br />J <br />I <br />I <br />I <br />I <br />I <br /> <br /> <br />Step 2- Review and Analyze (cont.) <br /> <br />Specific and aggregate stop loss contract noting specifically, <br />~ ~ Reimbursable or immediate specific claim payment <br />. ~ Maximum amount or specific coverage <br />;.. Exclusions of specific contract <br />;;~ Amount of risk retain by named carrier versus reinsured to tertiary markets <br />i~ Financial standing and ratings of reinsurance carrier(s) involved <br />, :l Ability of reinsurance carrier to non-renew or offer a higher specific stop loss on <br />selected individuals based on ongoing claims <br />;;.t¡; Discounts provided by reinsurer because of current TP A <br />;.~ Length of contract <br />;;~ Amount or percentage of commission currently being paid and to whom <br />¿~ Will reinsurance pay according to Summary Plan Document <br />...). Renewal guarantee, and # days prior to renewal rates become firm <br />;; ~ Lasering or raising specific stop loss amounts <br />;; Ii Aggregating specific amount <br />¿.; Period of reinsurance contract, run in, run out limitations <br />;\1 Rx included in the specific and aggregate limits <br />¿~ Pooling points and philosophy at renewal <br /> <br />Ancillary vendor contracts noting specifically, <br />iJ. Contract limitations and requirements <br />;,1 Period of rate guarantee <br />,;l Benefit levels <br />¿ å Analyze cost compared to self insuring benefit <br />i 1. Comparison of plan design to market <br />;,~ Geo access of network were applicable <br /> <br />Cobra, HIP AA, HIPP A Privacy compliance audit, <br />;; ). Review current policies and procedures and forms <br />,A Identify areas of non-compliance <br /> <br />y <br /> <br />Claims and Loss Data noting specifically, <br />i... Areas of high utilization <br />¿ ~ Actual chrims versus norm for region and industry <br />~'o. . PPO discounts <br /> <br />. , ...,". . <br /> <br />.~.. . .~-~ Employee versus dependent claims <br />,~ Inpatient versus outpatient claims <br />i <l Claims by place of service <br />;. ~ High cost claimants <br />;'.&. Paid claim distribution by claimant <br />è'~ Paid claim distribution by dollars <br />;;... Inpatient analysis by length of stay <br />iâ Inpatient analysis by average paid per day <br /> <br />CRIZZAFFI OARßY <br /> <br />GI) <br /> <br />B~"'/il lJ"i/Cti and M(HluJlt"'~1I1 <br /> <br />::r?""'~~y..~;:.; :'.i,~';;, ~~~'";;t~~%.¡r.~~::,! £:~"!Ä7~ ~";;;Y'ð">?o.~' .J\".ltl'l..;'-&~,~~~'..z,~~";~",'1W;¡ rr--<ù~'~!.x.iU' :l'4':d:~~ ~,~!II'J'lœ'=;"m::-ti <br />