GeneBridge is a reinsurance product created in response to high-cost gene therapy claims beginning to proliferate for the treatment of individuals with rare medical/genetic conditions. Programs that buy the coverage would be reimbursed a âscheduledâ amount for the therapy which includes an amount for the administration of the therapy.
The objective of this program is to mitigate the financial impact that one or more of these claims would have on the financial results of the reinsured program, health plan, or large employer group. It aims to promote financial stability and smooth out results.
Challenge of Gene Therapy = Severity + Frequency Risk
GeneBridge Overview
GeneBridge was developed to support the financial stability of an entire program block:
- Employer Stop Loss underwriters, including MGUâs, carriers, captive programs, health plans, and large employers with a captive.
Our program approach is characterized by:
- Broad coverage â FDA-approved therapies included
- Block basis â scale, competitive premiums
- Scheduled reimbursement – contracted rate use, basis for negotiations
- Retention options relative to underlying business
We offer two types of coverage:
Option A:
- Coverage for gene therapies currently approved by the FDA prior to the effective date. No new therapies added during agreement period.
Option B:
- Coverage for gene therapies currently approved by the FDA prior to and during the agreement period. For any therapies approved during the agreement period, the maximum limit of reimbursements will be $5,000,000, subject to the GeneBridge schedule of therapies.
Key Exclusions:
- Any person that began undergoing gene therapy or who had an Order Date by a physician for gene therapy prior to the effective date, except on renewals in which case the therapy is covered provided it was begun/approved in the previous policy period.
- Any person that receives an Order Date for gene therapy by a physician within the first 30 (thirty) days of the effective date.