risk pool

listen to the pronunciation of risk pool
Englisch - Englisch
A distinct population group, such as employees of a company, insured against costs of their potential use of health care resources Premium projections are based on variables such as the age of the covered population, health status, sex, occupation, group size, and location Structure can provide positive incentives to the participants, such as sharing savings when expenses are below projections; sharing losses when actual expenses exceed budgeted expenses, or a combination of these May also describe a financial arrangement among providers and payers to safeguard against unexpectedly high expenses or utilization
A pool of money that is at risk for being used for defined expenses Commonly, if the pool of money that is put at risk is not used by the end of the year, some, or all of it, is returned to those managing the risk
Funds are set aside to cover over-utilization or to encourage limits on utilization or to encourage limits on utilization More commonly seen in primary care than with specialists
Funds are set aside to cover over-utilization or to encourage limits on utilization More commonly seen for primary care rather than specialty care
A defined patient population and geographic location to which revenue and expenses are determined A risk pool seeks to define expected claim liabilities of a given defined account as well as required funding to support the claim liability
– A pool of money that is to be used for defined expenses Commonly, if the money that is put at risk is not expended by the end of the year, some or all of it is returned to those managing the risk
A portion of provider fees or capitation payments withheld as financial reserves to cover unanticipated utilization of services For example, if services provided exceeded the per member per month payment due to unexpected catastrophic claims, the dental health plan would still be able to pay providers from the risk pool
A pool of money that is to be used for defined expenses Commonly, if the money that is put at risk is not expended by the end of the year, some or all of it is returned to those managing the risk
risk pool
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