What is a Target Loss Ratio (TLR)?
This month we’ll be taking a closer look at various components of rating, starting with the Target Loss Ratio (TLR). A TLR, put simply, is a representation of the % of a groups premium that is available to pay claims. Every group has expenses, such as claims...
What is Mandatory Generic Substitution?
What is Mandatory Generic Substitution? Mandatory generic substitution is an option on the drug plan that controls on what basis a drug claim is paid. In situations where a lower cost generic alternative exists to a brand name drug, the drug plan will only cover the...
What is Stop Loss/EP3?
Stop Loss, often referred to as large amount pooling, EP3 or drug pooling, is additional protection sold as part of the Employee Health Benefits (EHB) portion of a Group insurance plan. Stop Loss is best compared to a more traditional insurance like house...
What is a Non-Evidence Maximum?
Non-Evidence Maximums, also referred to as NEMs, Non-Evidence Limits or NEL’s are the highest amount of coverage a plan member can have without providing medical evidence of good health. Providing NEM’s is an advantage to both the plan members and the...Deprecated: Function get_magic_quotes_gpc() is deprecated in /hermes/bosnacweb08/bosnacweb08ag/b1302/nf.pillowponcho/public_html/wp-includes/formatting.php on line 4387
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