Pool Administrators Inc.
A Connecticut Corporation
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THE 24 POOLS WE ADMINISTER IN 21 STATES are simple, safe and cost effective mechanisms that have been created to stabilize the marketplace by spreading the risk of adverse selection associated with a guaranteed issue environment in the small employer and individual markets. This stabilization should in turn allow the natural forces of supply and demand to improve access to health care at reasonable prices. The pools operate as small casualty property companies organized on a non-profit basis. The only incremental costs of these mechanisms to the pool members are administrative expenses, which are kept to a minimum through standardization, automation and our cost-effective administrative technique. In order to be cost effective, the administrative techniques we use are tailored to these nontraditional types of pools and, as such, our services are different from traditional administrative practices.
WE ADMINISTER INDIVIDUAL HIGH RISK POOLS which require special handling of people with significant health conditions. We handle the front end of the eligibility and enrollment process and then turn the risk over to the "best" practitioners to handle their care and claims administration. All other administrative "back office" and all consulting and staff support for the board of directors is our responsibility, as well. This unusual administrative technique has proven to be a highly effective way to provide best practices at the lowest cost.
WE ADMINISTER REINSURANCE POOLS AND RISK ADJUSTMENT MECHANISMS which are designed to be transparent to the high risk individuals and high risk small employer groups the carriers must insure. Therefore, our administrative practices assure that the high-risk individuals or the high-risk small employers obtain coverage and receive services in the same manner as their healthy counterparts without knowing of their special treatment. With these mechanisms, the carrier provides the coverage but it can either cede the risk to the pool and thereby can limit its losses, or it can participate in a formula |
based risk adjuster which may produce a positive or negative settlement.In these types of pools, the administrative technique we use allows the carrier to self-administer its own business and we simply "keep score" to assure that things are kept fair and equitable. Although we provide a "high touch" service to the carriers, we also seek out tools and practices that will keep the carrier’s administrative costs low.
OUR ORGANIZATION IS AN EXPERIENCED TEAM of highly respected professionals. Our staff includes a CPA and an accounting staff that maintains all of the financial records, manages cash, files tax returns, and produces regular financial statements. Our Benefits Administrators and our Client Consultants handle the day to day operations and our Account Team is staffed with quality assurance and account management specialists, as well as an executive account manager in the person of Karl Ideman, President and primary owner of this corporation.
OUR VISION OF THE BUSINESS AND TECHNOLOGY assumes that there will be more need for information from carriers, providers, and large employers to drive the spread of risk in the group and individual insurance markets. We see ourselves as the administrators of risk-spreading mechanisms, which use confidential databases and direct private links from the information providers to the administrator and then on to the regulators who oversee the risk-spreading process. We also see ourselves taking on certain functions that are not core functions that a company may want to outsource. Because of our ability to provide independent and special handling of high-risk individuals (people who readily use medical benefits), we can readily assume new business in related areas. We will be focusing on our pool administration, but we also will be interested in opportunities to apply our specialized administrative practices to applications where the customer wants to keep costs low and to provide specialized skills to administer the business. |
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