Managed Care Reinsurance

Products & Services

Managing Health Care Risks

We offer reinsurance products for HMOs, health plans and provider organizations. Products include:

Health Plan Reinsurance – We provide commercial, Medicaid and Medicare HMOs with solutions to help mitigate catastrophic exposure and offer tools and services that help clients address a wide range of financial risk areas.

Provider Excess Insurance – We analyze coverage needs, claims experience and financial risk to assist provider organizations in helping to minimize their financial exposure from catastrophic claims.

Delivering Cost-Saving Solutions

Our HM Navigator program provides specialty services and solutions that help protect our clients from the financial losses associated with catastrophic medical expenses. To achieve this, we bring together resources designed to complement existing bill reviews and controls without taking over the management of a clinical case or disrupting the timely adjudication of a claim.

Catastrophic claims management often requires multi-disciplined methodology. Using a clinically based approach to financial management, we can implement HM Navigator services to assist in a wide array of situations. Our HM Navigator program supports the specific needs of each client – before and after a claim is presented for payment.

Core HM Navigator program offerings include:

  • Negotiation for single cases or out-of-area claims
  • Independent bill reviews for financial payment accuracy, medical necessity and treatment protocols
  • High-cost case review, including clinical necessity assessment
  • Review of specialty pharmacy dosing and supplies (evaluation of number of units, cost of units, etc.)
  • Introduction and evaluation of transplant networks
  • Services addressing fraud, waste and abuse

Discover more about our program, products and services in Managed Care Reinsurance: Guarding the Financial Health of Plans and Providers.

In all states except New York, coverage is underwritten or reinsured by HM Life Insurance Company, Pittsburgh, PA, or Highmark Casualty Insurance Company, Pittsburgh, PA, under form HM PEL 1105, HC PEL 1105, HML 1105 ELR, HMC 1105 ELR, HM 1005-ELR or similar; in New York, coverage is underwritten or reinsured by HM Life Insurance Company of New York, New York, NY, under form HMNY PEL 1105, HMNY 1005 ELR or similar. The coverage or service requested may not be available in all states and is subject to individual state approval. Reinsurance agreements may only reflect a form number if required to by applicable law.