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U.S. Health Plans
Overview

RGA has the knowledge, capacity, and client focus to help you manage the challenges of a complex medical or managed care environment.

We can determine your risk exposure and help minimize its impact based on the most accurate information and at some of the most competitive rates available.

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RGA offers a range of group medical and/or managed care reinsurance products, including: 

  • Capital Motivated Reinsurance (CMR), or a means to leverage RGA’s global investment and risk knowledge, financial strength, and access to capital to deliver additional capacity; CMR can support planned sales growth, offset strain caused by acquisition costs, improve product return on equity, and reduce cost of capital
  • Excess Medical Reinsurance protection against the adverse effects of catastrophic claims
  • Health Plan (HMO) Reinsurance, a practical, cost-effective means to limit risk in this volatile market
  • Supplemental Health Reinsurance (Supplementary Reinsurance), or reinsurance over products that help reimburse health care costs not covered by primary health insurance, such as copayments, coinsurance, and deductibles
  • Quota Share Healthcare, a partnership in which reinsurer and ceding company each have a proportional share in a product's underwriting results.  This arrangement is common with Carriers / Managing General Underwriters serving fully insured and self-funded stop loss products

RGA offers a wide range of medical and managed care value-added services:  

ROSE® (Reinsurance Outcomes and Service Experts) Program
ROSE is the industry's premier medical and claims consulting program, providing:  

  • NCQA-accredited ROSEBUD® (Babies Undelivered and Delivered) Program, providing case management for high-risk pregnant women and high-risk infants
  • Medical management consultation and solutions, including case management program operational reviews 
  • Cost-containment solutions, with access to centers of excellence networks, and claim audit and negotiation services
  • Research and education, including our annual ROSE Conference and bi-monthly webinars

Account Management

  • Coordination as primary point of contact for contract and premium administration
  • Flexibility and simplification in administration
  • Periodic account reviews to ensure accuracy
  • Day-to-day customer support

Actuarial: 

  • Continuing education sessions
  • Benchmarking of rates
  • Peer review
  • Pricing assumption and algorithm review
  • Product development and pricing for unique risks
  • Predictive modeling
  • Reserve adequacy analysis and assumption review

Underwriting:

  • Plan design and policy reviews
  • Pricing and renewal strategy consulting
  • Experience rating methodologies
  • Large case and special risk underwriting support

Claims:

  • Claim turnaround in 30 days or less
  • Development of individualized claim reimbursement forms
  • Assistance in contract interpretation and claims adjudication procedures

Research and Surveys

  • Industry surveys
  • Ad hoc research services
  • Industry news curation
Contact Us

If you would like to request a proposal or are seeking more information, please:

Email Business Development >