Includes quota share, first surplus, second surplus, and all other sharing forms of reinsurance under which the reinsurer participates pro rata in all losses and in all premiums.
Insurance Encyclopedia
Participating or Pro-Rata Reinsurance
These are contracts where in the event of a loss, the amounts payable by a Direct Insurer and the Reinsurer are in proportion which are arranged before the loss. In other words, under proportional Reinsurance there is a common apportionment between the Ceding Company and the Reinsurer of original sum insured, of premiums and of losses according to a pre-determined percentage. Includes Quota Share, First Surplus, Second Surplus and all other sharing forms of reinsurance where under the reinsurer participates pro rata in all losses and in all premiums.
Participating pharmacy
Pharmacy that has signed a contract with an insurance plan to give medical services to the plan’s members.
Participating physician
1. A physician who contracts with an HMO or other insurance company to provide services to the plan’s members. 2. A physician who has agreed to accept a plan’s payments for services to subscribers (e.g., some Blue plans). Eighty percent of practicing American physicians are participating physicians. 3. Doctor or supplier who agrees to accept assignment on all Medicare claims. These physicians or suppliers may bill the patient only for the Medicare deductible and coinsurance amounts. Also called affiliated health care provider, participating provider, in-network provider, network provider.
Participating physician (par) agreement
1. Physician agrees to accept payment from Medicare (80% of the approved charges) plus payment from the patient (20% of approved charges) after the deductible ($131 in 2007) has been met. 2. Under the (TRICARE) program, the provider agrees to accept an assignment, agrees to accept the TRICARE-determined allowable charge as payment in full, and transmits claims to the regional contractor directly.
Participating policy
Annuity or life insurance policy in which dividends are paid to the policyholder. Also called a par policy. Also see participating insurance.
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UK: A with profits policy.
Participating Preference Share
A preference share which gives the holder, in addition to his right to a fixed dividend, a limited right to a share in the residual profits of the company.
Participating provider (Health Insurance)
A medical provider approved to participate in the Medicare program. These providers are paid directly by carriers.
Participating provider (par)
Physician, health care facility, or medical supplier that has a contractual agreement with an insurance plan to render care to eligible beneficiaries and bills the insurance carrier directly. Also called participating physician, in-network provider, network provider and affiliated health care provider. Also see participating physician, participating hospitals, participating dentist, and participating pharmacy.
Participating provider panel
Association of physicians and/or medical facilities or suppliers that are a single entity and enter into an agreement to provide specific services to all of a managed care plan’s members.