Medical Benefit Renewal Analysis

shugartx

New Member
2
Good Afternoon,
I have received a hypothetical case to analyze for Medical Benefits Renewal. I need to figure out the Required Premium Rate Adjustment. I was provided the following data:
Avg Enrollment
Current Enrollment
Adjusted Premium Avg
Adjusted Premium Current
Paid Claims
Less Pooled claims
Non-Pooled Claims
Estimated incurred claims
trend
projected claims
Projected Pooling
Total Projected claim
PPACA fees (3%)
Retention (16%)
Required Premium

And I need to figure out the required premium rate adjustment.

Does anyone have the formula or know where I can go to figure out how to get the required premium rate adjustment?

Thanks!
 
this is a relatively easy formula, but i have a question. it appears as though this is a project for you, so if it is, don't you think you should try it on your own? I will give you a hint, it is a very logical formula.

There is not enough information here for me to do this and I am assuming this is a large group. Try this.

Pd Claims during exp period x Incurred factor = Incurred Claims
Now adjust claims for; pooling point, pooling charge, benefit mandates, benefit changes and product change = Adjusted annual claims
Adjusted annual claims x trend factor (monthly factor x months) = Projected Claims
Now do your credibility adjustments, if needed.
x retention factor

This should get you through most, if not all.
 
Last edited:
Thank you for the guidance. I generally handle P&C claims so I felt out of my realm and was not sure where to look. I will work through it with the information you provided.
 
Thank you for the guidance. I generally handle P&C claims so I felt out of my realm and was not sure where to look. I will work through it with the information you provided.

When you are done, feel free to send it to me and I will review for you. Just send me a PM for my email
Lee
 
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