Risks are based on documentation of the presenting problem(s), the procedure(s) performed, treatments ordered, and other possible management options.

MEDICAL, US: 1. Individuals who comprise an insured group based on health status, age, sex, and future health. Also called risk spread . 2. State program that groups those who cannot obtain insurance coverage. Funds for these programs come from either the state or an assessment on insurers. 3. In managed care plans, a collection of funds established by a managed care plan that uses a risk-sharing system (i.e., capitation) with providers of medical services. Funds are taken from withholding a portion of provider fees or capitation payments to make up the reserve to cover unforeseen use of services. Funds that remain at the end of a year are distributed among the providers. Also called pool . 4. Financial account to which a managed care plan’s specific income and expenses are posted.
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Also known as a pool. A group of insurers (or reinsurers) who share the premiums and losses of a risk they have written together, according to an agreement that exists between them. A pool often writes large commercial risks.
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Multiple subjects of insurance insured or reinsured by a single insurer where, to avoid risk concentration and improve risk distribution, different combinations of exposures, perils, and hazards will be underwritten.