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Transplant Reinsurance Coverage
With the number of human and bone marrow transplants rising each year, as technology advances and donors and specialized centers become more available, Blue Cross and Blue Shield Plans need a reliable method to help them manage the risk of these very expensive, highly unpredictable cases. The BCSI transplant pool program is an innovative risk-sharing arrangement that represents the largest, longest-running pool in the nation, covering 15 million lives.
The BCSI organ and bone marrow transplant pool program covers the following:
Organ
Heart (including Circulatory Assist Devices)
Heart/Lung
Lung (single and double)
Liver (partial liver)
Pancreas
Pancreas/Kidney
Small Intestine
Bone Marrow
Coverage includes treatment for leukemia, lymphoma, blood diseases, genetic diseases and solid tumors including breast cancer.
Allogeneic
Autologous
Peripheral Stem Cell
Syngeneic
Umbilical Cord Blood
Plans that participate in the program receive first-dollar coverage up to $2,000,000 and are reimbursed for not only the costs due to the transplant, but also those for the underlying condition that triggered the transplant. Other covered services include Hepatic Assist Devices, procurement of the organ or bone marrow, and transportation. Also, all pool participants have access to the Blue Cross and Blue Shield Association's (an independent association of Blue Cross and Blue Shield Plans) Blue Quality Centers for Transplants.
BCSI has designed a unique financial arrangement for pool participants that allows them to share in the results of the program. Each year, we declare a provisional ceding commission that is paid to participating Blue Cross and Blue Shield Plans. Plans pay monthly premiums and, if their loss ratio is less than the pool's acceptable loss ratio, retain the provisional ceding commission. If a Plan's experience exceeds the acceptable loss ratio, it returns the commission on a point-by-point basis, not to exceed the commission paid. In addition, rate credits are awarded to program participants if both their loss ratio and the overall program loss ratio runs favorably.
For more information, please contact Theresa O’Shea at 630.472.7738 or at toshea@bcsigroup.com
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