HMO Reinsurance, also called HMO Excess or HMO Stop Loss, is a reinsurance policy that an HMO can purchase to share risk with an outside reinsurance company. The most common form of HMO Reinsurance is Stop Loss Reinsurance. In this case, the HMO purchases coverage from a reinsurer that triggers the coverage at a defined dollar amount, or stop loss deductible, on a per-patient basis.

Example: The HMO wants their HMO Reinsurance to trigger at $100,000. When the HMO has a member whose claims reach $100,000, they keep paying the claim, but every dollar above the $100,000 stop loss deductible is now eligible for reimbursement by their HMO reinsurance company. The HMO submits its claims to the HMO Reinsurer after it pays the claims, and the HMO Reinsurer reimburses the expense to the HMO.

Insolvence Reinsurance:

An HMO can buy this coverage to protect patients from an HMO’s insolvency. The reinsurer will pay the claims on any member who is an in-patient at the time of the HMO’s bankruptcy.

Purchasing an HMO Reinsurance Policy

HCP National Insurance Services, Inc. is an independent commercial insurance brokerage, serving healthcare organizations since 1994. We are also one of the largest brokerages in the country, led and owned by a certified minority woman.

We specialize in all forms of reinsurance and stop loss. If you are interested in learning more about HMO reinsurance coverage, please click here. Alternatively, if you are interested in getting a free quote for your insurance, please contact HCP today.