Case Study #1
A large, billion-dollar Regional Health plan had purchased reinsurance directly with a well known reinsurer. RSC was asked to review their program, including terms of coverage. During the review of the treaty wording, RSC determined the Health plan had been paying premiums on members that they could not collect reinsurance on under the coverage outlined in the treaty. Armed with this data, the carrier went back to the reinsurer and negotiated a substantial six-figure refund on these members.

Case Study #2
A carrier relationship with an MGU that predated RSC’s involvement had been silent regarding the payment of profit commissions to the MGU on their net retained line. RSC was able to negotiate a profit commission payment from the carrier equal to that paid by reinsurers under the program, resulting in additional revenue paid to the MGU.

Case Study #3
The premier health plan in their market area had been experiencing a break down in communications between their Managed Care department and their Finance/Claims area. The Managed Care department had been focusing exclusively on the clinical outcome aspect of patient care without access to or knowledge of patient claim activity. This restricted finance capabilities to set reserves accurately and adversely impacted their profitability. RSC and the new reinsurer set up a reporting system where information was shared on open access platform resulting in a more accurate reserve calculation.

Case Study #4
An MGU had been notified by their reinsurer, after their renewal date, they were no longer able to retrocede to the MGU’s offshore captive. The captive’s participation was crucial to the MGUs business plan. RSC was able to procure retrocession support from a specialty reinsurer retroactive to the effective date, enabling MGU to continue operations with support of their carrier partners.

Case Study #5
Another large health plan had been experiencing rapid growth in their marketplace, outpacing the necessary capital to maintain adequate RBC ratios. The health plan reviewed several options, including a Surplus Relief Financial Reinsurance program procured by RSC. Senior management found this option to be superior to all others but faced resistance from their board and auditors (due to negative publicity in industry). RSC was able to provide documentation from NAIC, FASB State of Domicile and other regulatory parties substantiating both the merit and legality of the arrangement. The health plan ultimately received approval from their board, auditors and state and cover was placed without prejudice.