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A process through which insurance plans that enroll a disproportionate number of sick individuals are reimbursed for that risk by other plans who enroll a disproportionate number of healthy individuals. The ACA requires states to conduct risk adjustment for all non-grandfathered health insurance plans.
A statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when looking at their health care outcomes or health care costs.
- Browse Related Terms: Actuarial justification, Adjusted community rating, Age Rating, Annual Limit, Community rating, Guaranteed Issue, Guaranteed renewability, Guaranteed Renewal, Health Status Rating, Interstate compact, Lifetime limit, Medical Loss Ratio (MLR), Multi-state plan, Qualified health plan, Rate Review, Rating Factors, Rescission, Risk Adjustment, Small group market