1. In managed health care, an averaging after a flat rate is given to certain categories of procedures. 2. Package price for a specific procedure or diagnostic-related group (DRG). Also called bundled rate or flat fee-per-case .
Insurance Encyclopedia
Case reserve
reserves for outstanding claims built up on a case by case basis with the amount likely to be paid out on each claim being separately estimated.
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Known also as outstanding loss reserves, case reserves are recorded estimates of outstanding unpaid liabilities associated with specific reported claims. Case reserves may pertain to losses, allocated loss adjustment expense (ALAE), or both. Case reserves are established by the cedant if the reinsurer believes a case reserve is inadequate, it may establish an additional amount known as the additional case reserve (ACR).
Case summary card
Form sent by an insurance company’s home office to a branch office that condenses important information about a new case or a change in an existing case. Also known as an abstract.
Case universe
Database of billed insurance claims from which CMRI selects the specific review category samples.
Case-rate capitation
In managed health care, payment to specialists such as orthopedists, urologists, and oncologists based on either referral or episode of care of the patient. Also called contract capitation.
Cash accumulation method (Life Insurance)
Method of comparing the cost of life insurance policies with the same death benefit. The differences between the premiums paid to each policy are kept and accumulate interest at a given rate. At the end of a predetermined time frame, the largest amount accumulated from the difference of premiums paid is considered the most cost effective.
Cash accumulation policy
Pensions term, referring to an insurance policy under which contributions net of expenses are accumulated in a pool to which bonuses and interest are added. The proceeds are used to buy pension benefits as they become due.
Cash basis
Costs of the service when payment was made rather than when the service was performed.
Cash call
A request for funds made by a managing agent to members of a syndicate.
Cash call/loss clause
A proportional reinsurance clause that permits a cedant, on settling a loss above a given sum, to obtain immediate settlement to avoid waiting for the periodic payment. The clause cannot be implemented if the cedant owes outstanding balances to the reinsurer.