Funds from the premiums that the insurance company returns to a group insurance policyholder after analyzing the claims incurred, expenses, risk charges, changes in reserves, and profit.

Process in which coding for medical services occurs after the patient is discharged from the hospital.

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.

System of establishing rates in which the current year’s insurance premium is calculated to give the actual current year’s loss experience (usage of health care). Gains may be returned by rate credits or increase of benefits or cash, and deficiencies are obtained through a recovery factor in the rates or cash. Also called retrospective rate derivation .

Payment made to a provider by the insurance company for actual costs or charges incurred by the insured during the previous time period. Also called retroactive reimbursement .

Method that sets the payment rate for hospital services after services have been provided.