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Risk Assessment Solutions

NEXtCARE designs Plans and Products which are intended to be covered by the payer (Risk Carrier) after consultation with them and thorough market analysis of the territory. NEXtCARE provides an automated underwriting rules tool that allows the payer to:

  • Define proposed risk units,
  • Set parameters for coverage eligibility per plan,
  • Fix corresponding Premium tables,
  • Choose from an additional range of optional automated features to assign other eventual specific restrictions.

In addition, through direct access to NEXtCARE's Integrated Management System, payers (risk carriers) have the possibility of directly accessing their corresponding Reinsurance Account. NEXtCARE is also in the position to take charge of issuing Statements of Account per Reinsurance Accounting Period.

Using NEXtCARE TATSH will not limit the payer to the above; the payer can benefit from several features such as being able to:

  • Query Contract Holder balances,
  • Update Contract Holder balances by entering payments made by Contract Holders as well as automatically crediting refunds and or claims due amounts to each Contract Holder account,
  • Issue transfer orders on behalf of the Payer for claim payments and/or for Reinsurance Positive Balance settlement and forward amounts to Escrow account bank managers,
  • Maintain (in the system), on a daily basis, the general ledger accounting entries pertaining to the Payer's Health Insurance activities,
  • Access to Escrow account movement and balance tracking when applicable,
  • Query and print receivable statements,
  • Query and print payable statements,
  • Enter in detail confidential Payer overheads pertaining to the Payer's Health Insurance activities,
  • Query and print confidential profit and loss accounts pertaining to the Payer's Health Insurance activities,
  • Maintenance of distributors accounts.

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