Managed Care Insurance Consultants - Reinsurance Provider Stop Loss Insurance Health Insurance Group Insurance Construction Insurance

Managed Care Insurance Consultants - Reinsurance Provider Stop Loss Insurance Health Insurance Group Insurance Construction Insurance

We are here to serve you at Managed Care Insurance Consultants - Reinsurance Provider Stop Loss Insurance Health Insurance Group Insurance Construction Insurance
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Our customers enjoy distinctive and personal attention to assist them in all personal and commercial lines of insurance needs.  Our level of administration efficiency in underwriting and actuarial support permits us to pass on the savings to our clients in the form of lower than average premiums.

 


REQUEST FOR PROPOSAL

HMO REINSURANCE QUESTIONNAIRE


After completing the form below press
or

Name of HMO:
Street Address:
City:    State:    Zip: 
Mailing Address (if different from above):
Telephone Number:  Fax
Chief Executive Officer:
Chief Financial Officer:
Medical Director:
Marketing Director

CONTACT PERSON:
Name:  Title: 
Date Submitted: 
Date Proposal Needed: 
Effective Date of Reinsurance:

GENERAL QUESTIONS:
1.  Type of HMO:  Group   Staff    IPA     Network
2.  HMO is:  For Profit    Not for Profit
3.  Primary ownership of HMO:
4.  Expected enrollment in 12 months:
5.  Is Medicare to be covered by Reinsurance?  Yes    No
6.  Does this HMO have Professional Liability?  Yes    No
     a.  Insurance Carrier:
     b.  Limits of Liability:
     c.  Expiration Date:
7.  Does this HMO have Directors and Officers Liability?  Yes    No
     a.  Insurance Carrier:
     b.  Limits of Liability:
     c.  Expiration Date: 

CURRENT REINSURANCE TERMS:
1.  Name of Carrier:
2.  Expiration Date of Coverage:
3.  Renewal Premium Per Member Per Month:
4.  Does the HMO have Professional Liability    Yes  No
5.  Where do you provide the following tertiary care?
     Premature Infants:
     Cardiovascular Care:
     Burns:
     Organ Transplants:
     Severe Trauma:

6.     List tertiary services which are capitated.


 
ADDITIONAL DOCUMENTS TO ACCOMPANY THIS QUOTE REQUEST
 ( Please fax these to (305) 598-9806 )

1.     Copy of current Reinsurance Policy.
2.     Copy of HMO Benefit Plan to members.
3.     Specimen copy of hospital agreement (and physician agreement, if applicable).  
        If there are per diems, capitation and/or discounted arrangements, provide a 
        copy of the reimbursement arrangement of each.
4.     Copy of the latest audited Financial Statement, latest available unaudited interim
        financial statement, and latest quarterly NAIC Report.

All the above copies can be emailed to hmoreinsirance@mcicgroup.com or sent by fax to (305) 598-9806

5.     List of past three (3) years claims experience for all members whose charges 
        exceeded the deductible.  Include:
        Dates of service
        Date of birth (or similar identification)
        Reason for hospitalization (Diagnosis)
        Hospital
        Payment basis, e.g., DRG, per diem, FFS, etc.
        Total amount of hospital bills related to the above hospital days
        If physician coverage is included, total amount of physician charges
        Amount recovered from reinsurance
6.     Listing of all current members presently under treatment whose total expenses
        are expected to exceed the deductible before the end of this contract period.  
        Include the following:
                    Dates of service

        Hospital

                    Prognosis
                    Expenses incurred to date
                    Expenses expected to be incurred
                    Listing of all current members who are potential reinsurance claims for

         the upcoming contract period

 List Below:

Press after correctly filling out the above fields.
  Press
to clear the form and start over.

 

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    All Rights Reserved. 
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