Department of Army Medical Command. Fiscal Year 1996. CHAMPUS Catastrophic CaseLimits, with Comparison of Case Limit Estimate Derivations Using One Year Versus Three Years of Past Historical Data, TRICARE Catchment Areas

摘要

This report presents the estimation of case total limits for catastrophic re-insurance payments to be made to thirty-four Army TRICARE catchment areas for Fiscal Year (PY) 1996. ase totals include both institutional and professional services CHANPUS payments. FY 1995 data were used to derive the final estimates. The final catastrophic case cutoffs are listed in Table 1 as part of the report Summary. These cutoffs, when implemented by Army Medical Command (HQ MEDCOM), will result in approximately 5% of each catchment area's total annual CHAMPUS budget being paid through catastrophic re-insurance. Appendix A lists the actual case limit cutoff computations for each site and displays thresholds associated with various percentages of the budget paid as reinsurance. Appendix C displays each catchment area's Privacy Act protected catastrophic cases which satisfied the 5% cutoff criteria during FY 1995. Table 2 and Appendices B and D reflect similar computations when using a three year rather than a one year historical basis for deriving the case limit estimate amounts.