Contract between a self-funded insurance plan and an insurance company or third-party administrator (TPA) whereby the insurance company provides administrative services only and assumes no risk. Usually, this is an employer’s group health insurance program and it retains financial responsibility for payment of the insurance claims. Services include actuarial activities, benefit plan design, claim processing, data recovery and analysis, employee benefits communication, financial advice, medical care conversions, preparation of data for federal reports, and stop-loss coverage. Also known as ACS contract.
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Contract between an insurer (or its subsidiary) and a group employer, eligible group, trustee, or other party, in which the insurer provides certain administrative services. These services may include actuarial support, plan design, claims processing, data recovery and analysis, benefits communications, financial advice, medical care conversions, data preparation for governmental reports, and stop-loss coverage.