Across
- 1. - A document or request filed by a policyholder, beneficiary or other stakeholder stating that an insured event has occurred and that the insurance company should provide coverage.
- 6. Amount - The maximum amount a plan will pay for a covered health care service.
- 8. Care Organization (MCO) - The entity contracting with the state Medicaid agency to provide health care services for selected subsets of the Medicaid population.
- 13. razor - also known as the principle of parsimony or the law of parsimony
- 15. - Portion of the insured loss (in dollars) paid out of pocket by the policy holder before an insurance provider pays any expenses
- 16. - A financial contract between an insurance company and the policy holder (purchaser) that provides for a series of payments at regular intervals to be received for a number of years or over a lifetime.
- 17. But Not Reported Reserve Provision (IBNR) - Amount owed by an insurer to all valid claimants who have had a covered loss but have not yet reported it.
- 19. - A fixed amount one pay for a covered health care service after the insured pays the deductible
- 21. Withhold—An amount included in the capitation rates that is paid if the MCO meets certain state requirements that may be related to quality or operational metrics
- 23. Period—The time period for which managed care Medicaid capitation rates are being developed.
- 24. Flow - Movement of money
- 25. - Federal agency overseeing Medicaid waivers (ABBRV)
- 26. Ratio - The ratio of total losses incurred in claims divided by the total premiums earned.
- 27. Corridor - Shared gain/loss arrangement between state and plan
Down
- 2. Communication - A written, electronic, or oral communication issued by an actuary with respect to actuarial services
- 3. Medical Loss Ratio—A provision that requires the MCO to use no less than a stated portion of its earned premium for defined medical or care management expenditures.
- 4. - The incidence of death in a population.
- 5. - A transaction between a primary insurer and another licensed (re)insurer where the reinsurer agrees to cover all or part of the losses and/or loss adjustment expenses of the primary insurer, for a premium.
- 7. - Percentage of capitation held back pending performance
- 9. - The greater tendency of people with a more than average likelihood of loss to apply for or continue insurance, when compared with other people.
- 10. - a measure that takes on values from zero to one and gives the likelihood of occurrence of an event.
- 11. - The rate of disease in a population.
- 12. - General term for smoothing numerical information using a set of data points to arrive at a single value (measure of central tendency) to represent those data points.
- 14. Value - a numerical value assigned to a given set of actuarial risks that is determined using an actuarial model of those risks
- 18. - Liability set aside to pay future claims
- 20. - a person who applies mathematical approaches to anticipate, measure and manage risk.
- 22. Assessment - is the quantification of actuarial risk
- 23. Adjustment—The process by which relative risk factors are assigned to individuals or groups based on expected resource use and by which those factors are taken into consideration and applied
- 25. - a measure of the extent to which a change in one random variable occurs simultaneously with a change in another random variable.