Process in which coding for medical services occurs after the patient is discharged from the hospital.
Insurance Encyclopedia
Retrospective cover
Liability policy extension bringing within a losses-occurring policy on a claims-made basis bodily injury or damage caused prior to the inception of the policy but for which no previous policy can be traced. ‘Retro’ cover closes gaps in the insured’s insurance history but does not respond to shortfalls in cover in traced insurances. ‘Retro’ cover should embrace the insured’s previous activities as the current business description may not apply.
Retrospective Date
The first date for which claims will be paid under a claims-made policy of liability insurance.
Retrospective excess of loss
Finite risk cover for IBNR losses under which the reinsured pays a premium for the (partial) assumption of losses that exceed the accumulated reserves. Contracts may be structured as: stop loss treaties, working excess of loss treaties or catastrophe excess of loss basis.
Retrospective for Rating
A rating method under which the insured’s premium depends upon the insured’s own loss experience subject to minimum and maximum premium constraints. Usually used in Group Mediclaim and Group Personal Accident Policies. In a similar yet different approach a provisional premium is paid at the beginning of the policy period and at the end of the period a final premium is computed based on the actual loss experience during the period. It is also widely used for Workmen’s (Employee’s) Liability Insurance, Liability Insurance policies, Motor Act only Policy, Property damage and Burglary Policy for large firms.
Retrospective payment audit
See: retrospective review .
Retrospective premium
The last premium paid on a retrospective rating plan.
Retrospective premium agreement
Contract in which the policyholder pays the insurance company for any deficiencies incurred when the insurer agrees to continue coverage at a premium rate that eliminates any rise and fall in claims.
Retrospective Premiums
Premiums dependent on loss experience during the year.
Retrospective rate derivation (Health Insurance)
A type of rating system wherein an employer pays a fraction of the employee’s cost for health care. The insurer may have to refund some of the money paid, if the costs for health care turn out to be less than the amount the employer has agreed to pay.