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Insurance for insurance providers that have higher than anticipated health care claims. This program seeks to lower the premium insurers charge by limiting the high health costs they are exposed to. The Affordable Care Act establishes a reinsurance program for insurers participating on the exchanges, and if an enrollees costs reaches a certain amount (the “attachment point”) the program with reimburse for a portion of the costs above that amount.

Utilization Review (UR)

Refers to the evaluation of the efficiency and need of health care services, including procedures and facilities, according to established criteria of the provisions of…