The Ionic Group, a Provider Group with 10,000 Plan Members

question 179

Multiple Choice

The Ionic Group, a provider group with 10,000 plan members, purchased for its hospital risk pool aggregate stop-loss insurance with a threshold of 110% of projected costs and a 10% coinsurance provision. Ionic funds the hospital risk pool at $40 per member per month (PMPM) . If Ionic's actual hospital costs are $5,580,000 for the year, then, under the aggregate stop-loss agreement, the stop-loss insurer is responsible for reimbursing Ionic in the amount of

• A) $30,000
• B) $270,000
• C) $300,000
• D) $702,000

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Definitions:

Merchant Customer

A consumer who has a commercial relationship with a business or merchant, typically involving the purchase of goods or services.

Dispatch

The act of sending something or someone to a specific destination or for a certain purpose.

Acceptance

The act of agreeing to receive something offered or the acknowledgment of a new contractual proposal.

Predominant-Purpose Test

A legal test used to determine the primary objective or nature of a contract when it serves multiple purposes, impacting enforcement and interpretation.