Covered vs Uncovered

[LuciP-DH]

We are a fairly new start up in healthcare so we are coming across figuring out how to best allocate balances between covered and uncovered in the financials. I am hoping to get some feedback as to how others set this up to report on the financials. Thank you.

[Glenn]

Hello,
I can provide the guidance and definition on covered vs uncovered from an excerpt from the Health Annual Statement seminar that I teach as Booke's Lead and only Health instructor.

Please note the excerpt below: ( source NAIC instructions)

LIABILITIES, CAPITAL AND SURPLUS

Column 1 Covered

Include: Liability categories not included in Column 2. State statute or regulation may define these liabilities.

Column 2 Uncovered

Include: The liabilities for the costs to the reporting entity for health care services that are the obligation of the reporting entity, for which an enrollee may also be liable in the event of the reporting entity?s insolvency and for which no alternative arrangements have been made that are acceptable to the commissioner (director). These costs will vary in type and amount, depending on the arrangements of the reporting entity. They may include out of area services, referral services, and hospital services.

Exclude: Services when a provider has agreed not to bill the enrollee even though the provider is not paid by the reporting entity.

Services that are guaranteed, insured or assumed by a person or organization other than the reporting entity.

GS : Allocations will vary by reporting entity. Note it usually out of area or out of network costs. Uncovered as % of total Liabilities is only about 3% ( per Best reports).

Regards,