BUILDING BLOCKS > MANAGER > RISK POOLING & PLAN FUNDING

Risk Pool

How are individuals grouped to allow payers to offset the cost of individuals with high medical expenses with healthier individuals with lower medical expenses?

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Community Rating

Policy Definition: Community Rating is a method of varying premiums within a geographic area based on age, gender, health status or other factors. source

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High-Risk Pools

Policy Definition: A high-risk pool plan offers publicly subsidized health insurance coverage to eligible, usually high cost individuals. Typically, high-risk pool premiums are up to twice as much compared to individual coverage premiums for a healthy person. source

Risk Corridor

Policy Definition: A risk corridor limits losses and gains beyond an allowable range by collecting funds from plans with lower than expected claims and makes payments to plans with higher than expected claims. source

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Risk Adjustment

Policy Definition: Risk adjustment is a method to offset the cost of providing health insurance for individuals who are at higher, long-term risk due to chronic conditions. source

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