Establishing an Analytical Framework for Measuring the Role of Reinsurance in the Health Insurance Market. 2. HMO Reinsurance

03/20/1997

Most of the discussion above related to gathering additional reinsurance data for the indemnity market is equally applicable to securing additional data about HMO reinsurance. The NAIC HMO annual statement is the best current source of detailed information on HMO reinsurance arrangements and the most logical source of additional information on the topic. The additional details that we described in the section above on variables for understanding reinsurance arrangements are actually only minor additions and clarifications to the type of information that many HMOs provide now in the annual statement. In fact, the clarifications related to the type of services being reinsured and the presence of any retention of risk about the stoploss thresholds would actually improvethe usefulness of the information for regulators, who would be in a better position to evaluate the arrangements' effects on solvency. This may reduce potential opposition from the NAIC or the HMO industry to making such changes.

If additional information cannot be gathered through the NAIC HMO annual statement, the most likely other sources of information are the private companies and associations that collect and disseminate information on HMOs. Interstudy is one such company; the American Association of Health Plans also collects and disseminates information about HMOs gathered through an annual survey of its member companies. As with indemnity insurance, however, the rather narrow demand for this type of information may discourage these sources from collecting and disseminating the information.