Products & Services

Managing Health Care Risks

We offer reinsurance products for HMOs, health plans, provider organizations and ACOs under the name RBS Re. 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.

ACO Reinsurance – We assist ACOs and other licensed health plans and risk-bearing entities with financial strategies that help to protect against the catastrophic claims that exceed selected retention and coinsurance levels.

Employer Stop Loss – We use marketplace knowledge and reinsurance expertise to provide a variety of Stop Loss solutions for health plans with self-funded or administrative services only (ASO) groups.

Delivering Cost-Saving Solutions

Our 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 Navigator services to assist in a wide array of situations. Our Navigator program supports the specific needs of each client – before and after a claim is presented for payment.

Core 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.

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Disclaimer In all states except New York, coverage is underwritten or reinsured by HM Life Insurance Company or Highmark Casualty Insurance Company, Pittsburgh, PA, under policy form series HM PEL 1105, HC PEL 1105 or 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 policy form series HMNY PEL 1105, HMNY 1005 ELR or similar. RBS may provide certain administrative and customer support services. RBS Re, South Miami, FL, may provide certain administrative and customer support services. The coverage or service requested may not be available in all states and is subject to individual state approval.