An alternative fully-insured funding arrangement that includes an annual settlement using group-specific
premium
premium
Payment to your insurance company for health and prescription drug coverage. If you receive health insurance through your employer, your premium may be deducted directly from your paycheck. If you have separate health and dental insurance, you would have two premiums. If you don’t pay your premium, your health care coverage will be cancelled.
and claims. The annual settlement compares premiums paid to claims and expenses to determine an
underwriting gain
underwriting gain
The carrier's gain incurred when claim costs plus all other (excluding federal income taxes and investment income) carrier expenses are less than the amount collected in premiums.
or loss. Employers receive a portion of underwriting gains and may be subject to a
risk charge
risk charge
A fee included in certain insurance products which compensates the insurance company for risks it assumes under a contract.
and/or balance carry-forward for underwriting losses.