A referral is a physician's recommendation for an individual to see a practitioner, specialist, or out-of-network provider. Depending on the type of plan in which the participant is enrolled, the participant may need a referral in order for the plan to cover or consider such services at the in-network benefit percentage.
Reinsurance is a contractual arrangement whereby a reinsurer agrees to assume a portion of the risk that a stop-loss carrier or insurance company underwrites, which spreads the risk among two or more insurance carriers.
The term "renewal" means continuing a contract for administrative services on the same terms and conditions as the initial or previous contract.
The term "routine" refers to services that individuals receive for the purpose of promoting health and preventing illness or injury, including evaluation and management of individuals when they receive these services in the absense of patient complaints.
A run-in contract is a type of excess-loss policy that covers claims with service dates and paid dates beyond the excess-loss policy year, but within a period as stated in the excess-loss schedule. Common run-in options are a 15/12 contract, which covers eligible claims that participants incur three months prior to the plan's effective date and all claims paid during the 12 months following the effective date, and an 18/12 contract, which covers eligible claims that participants incur six months prior to the plan's effective date and all claims paid during the 12 months following the effective date. Run-in contracts are typically purchased when a plan switches excess-loss carriers or third-party administrators (TPAs).