Underwriting

Underwriting combines science and art to provide our clients with an appropriate balance of risk and reward. Achieving this balance is accomplished through a blend of standard underwriting practices and utilization of marketing leading risk management strategies which are orchestrated through our third-party administrative partners.The underwriting of each group is straightforward and includes a review of month by month claims, large claims, enrollment history, current census, as well as rate history and plan design. Where available we use a claim detail report to provide insight into utilization trends by service type and disease states, which are used in our costs projections and risk management recommendations. Large claim reports are evaluated based on diagnosis, prognosis and potential long-term costs and their impact on the plan’s financial performance. Our primary goal is to issue quotes that offer an employer the most cost-effective solution for their health plan.

Unfortunately, not all groups perform as well as expected. As a result, the underwriting process may use a variety of risk management tools to control risk and aid the employer in managing overall costs. Some of these tools may include aggregating specific deductibles, laser pools, individual lasers or modified contract terms. Our desire is to issue coverage without modifications though we find that employers want the option of choosing increased premiums or an increased deductible on a specific individual. In addition to standard solutions, Prodigy has the ability to use other tools including split deductibles, co-insured aggregate layers and maximums on R&C for reimbursement amounts. The goal is to assist you, the TPA and broker in providing effective solutions for your clients.


Coverage Options
Minimum Group Size: 50+ covered employees (lower on an exception basis)
Minimum Specific Deductible: $25,000 (lower on an exception basis)
Contract Periods
New business: 24/12, 18/12, 15/12, 12/12, 12/15, 12/18
Renewal Business: All of the above plus Paid and 12/24
Policy Limits
Specific Coverage: Unlimited
Aggregate Coverage: $1,000,000 per policy year ($2,000,000 available)
Aggregate Only Coverage: 12/12, 12/15, 12/18 (available for level funded programs)Optional ProvisionsSpecific Coverage: Specific advance
No Laser on renewal (Laser alternatives available)
Aggregate Coverage: Aggregate Accommodation
Terminal Liability

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