Reinsurance

Reinsurance Setting

An enrollment product type can have one or more reinsurance settings. A reinsurance setting specifies the percentage that should be paid out to a reinsurer.

Table 1. Reinsurance Setting

Field	Description
Enrollment Product Type	The enrollment product type for which the reinsurance setting is applied
Organization	The organization that acts as a reinsurer
Percentage	The percentage of the premium that has to be payed to the reinsurer
Alias Code	The alias code for reinsurance (this is transferred to OHI Claims in the enrollment response if reinsurance is applied)
Start Date	The start date of the reinsurance setting
End Date	The end date of the reinsurance setting

Constraints:

• It is not allowed to have an overlap in time validity for reinsurance settings with the same enrollment product type, organization and alias code

Reinsurance Exclusion

A reinsurance setting can have one or more reinsurance exclusions. A reinsurance exclusion specifies the premium types, adjustments and surcharges that are excluded from the base amount used for the reinsurance payment calculation.

Table 2. Reinsurance Exclusion

Field	Description
Reinsurance Setting	The reinsurance setting for which the exclusions apply
Premium Schedule Type	The excluded premium schedule type
Schedule Definition	The excluded schedule definition

Note that not all schedule definitions are relevant to reinsurance. For example, schedule definitions that belong to the Fee schedule definition type have no relevance within the context of a reinsurance exclusion.

Reinsurance Treaties

The following entities are used to store the reinsurance treaty related details:

Reinsurance Treaty Types

Table 3. Reinsurance Treaty Types

Field	Description
Code	The code of the reinsurance treaty type.
Description	Treaty type description.
Display name	Display name for the reinsurance treaty.

Reinsurance Treaties

Table 4. Reinsurance Treaties

Field	Description
Code	The code for the reinsurance treaty.
Description	Description of the treaty.
Type	The type of the treaty, reference to reinsurance treaty type.
Retention percentage	The percentage of the premium retained by the payer or costs per claim for the payer.
Retention amount	The maximum amount for which the payer is liable, typically per member or policy.
Excess of loss amount	The maximum amount for which the payer is liable, typically per group of policies or catastrophic event.
Commission percentage	Commission percentage which the payer collects from the reinsurer.
Priority	Priority in which the treaty is to be applied.
Enabled?	Reinsurance Treaty enabled?.
Start Date	Start date for the reinsurance treaty.
End Date	End date for the reinsurance treaty.

Reinsurance Treaty Reinsurer

Table 5. Reinsurance Treaty Reinsurer

Field	Description
Reinsurer	The organization that acts as a reinsurer.
Percentage	Reinsurer’s percentage split.
Treaty	Reference to the reinsurance treaty.

Reinsurance Treaty Premium Scope

Table 6. Reinsurance Treaty Premium Scope

Field	Description
Schedule Definition	The included schedule definition.
Premium Schedule Type	The included premium schedule type.
Treaty	Reference to the reinsurance treaty.

Reinsurance Treaty Benefit Scope

Table 7. Reinsurance Treaty Benefit Scope

Field	Description
Service Option Service Code	Service codes that are included in the treaty.
Treaty	Reference to the reinsurance treaty.

Reinsurance Treaty Enrollment Scope

Table 8. Reinsurance Treaty Enrollment Scope

Field	Description
Enrollment Product	The enrollment product to which the treaty applies.
Group Account Product	The group account enrollment product to which the treaty applies.
Group Client	The group client to which the treaty applies.
Treaty	Reference to the reinsurance treaty.