Acronyms
IPC
Incurred and Paid Claims
Maximum insured can pay during benefit period
Max-Out-of-Pocket
An organization that processes claims and performs other administrative services in accordance with a service contract, usually in the field of employee benefits.
TPA (Third Party Administrator)
=Gross Premium - Claims - Expenses
Profit
The NFL team defeated the Kansas City Chiefs in Super Bowl LIX to win its second championship
Philadelphia Eagles
DY
Duration Year
A different, higher spec deductible for an individual with a known condition that is likely to exceed the spec deductible for the rest of the group
Laser
The general increasing nature of claim rates.
Trend
= Incurred Claims - Incurred and Paid Claims
Reserve
This school won four consecutive NCAA Women's College World Series from 2021 to 2024
University of Oklahoma
FDCR
First Dollar Claim Reserve
the amount paid by the insured before the coinsurance begins
Deductible
Issues the benefit package that the TPAs sell (the “name on the paper”)
Carrier
= Expected Claims * Attachment Point
Funding
This NCAA women's basketball program completed a perfect 38-0 season in 2024 to win its third national championship
University of South Carolina
TEC
True Expected Claims
an additional corridor above the specific deductible that the employer must absorb before the stop-loss carrier reimburses claims.
ASD (Aggregating Specific Deductible)
When conducting renewals, extraordinary and/or acute claims are pulled out of the experience analysis if the analyst/underwriter believes they will not recur during the rating period.
Pooled Claims
=(Incurred and Paid Claims) / Premium
Paid Loss Ratio
This MLB franchise ended an 86-year championship drought by winning the 2004 World Series
Boston Red Sox
Benefit, Pooling, Duration, Trended Adj Incurred Claims
The component of a stop-loss rate that, over the course of the policy, totals the aggregate attachment point.
Claim Funding (Agg Factors)
Refers to historical premium, enrollment, and claim activity during a specified period.
Experience
= (Funding+(1-Expense Load)×Premium) / (1+Surplus Factor+Profit Load)
LEC
This university is the only school to win national championships in football, men's basketball, and baseball in the 21st century.
University of Florida