Hagan Benefits, Inc. / Governmental Pools / HPSD FAQs Q: Why was the health pool created?
• Proposed health care reforms • BC / BS split and SDML request • Increasing insurance costs and medical inflation • Success of pooling Q: How does the pool work? A: The pool is an insuring mechanism which spreads the risk across a large group. Premium dollars are split between BUDGET (expected claims, reinsurance and administration) and RESERVES (for catastrophic claims). The portion of reserves not used to pay claims is traditionally the insurance company’s profit, but in a pool the excess reserves are shared with members. Q: How does a claim work? A: Claims of less than the reinsurance retention are paid for/shared by the pool. Claims greater than the retention are paid 100% by the reinsurance company. Q: Will our deductibles rollover from our current insurance? A: Yes, we will honor any deductibles and co-insurance that have already been met. Q: Do prescriptions count towards your deductible? A: Yes, if you do not have a $15 Generic; $25 Formulary; $35 Non Formulary Pharmacy Card c
