Exhibit_11_MAPD_Rate_Setting.xlsx
XLSX spreadsheet 59 KB Posted
- Attached to
- OEIBA Program Commercial HMO, MSP, and MAPD Plans State and local contract opportunity
- Solicitation number
- EV00000681
- Issued by
- Oklahoma County, Hobart City, Oklahoma
About this file
The document is an Excel spreadsheet titled "Exhibit 11: MAPD Rate Setting Support" for a Medicare Advantage Prescription Drug (MAPD) plan, designed for rate setting and pricing proposal purposes. The spreadsheet contains four tabs (11a, 11b, 11c, and 11d) that provide detailed cost proposals and rating methodologies for both scenarios with and without proposed benefit changes. The document appears to be a template for a Medicare plan offering fully insured pricing for the plan year 2026, with sections for medical and pharmacy assumptions, fixed costs, CMS revenue, and group rates.
The spreadsheet is structured to allow a supplier to complete detailed rate-setting information, including PEPM (Per Employee Per Month) rates, ACA insurance industry fees, medical and pharmacy claims trends, administrative costs, state premium taxes, and various revenue components such as plan benchmarks, rebates, and quality bonus payments. While all monetary fields are currently populated with $0.00, the template is designed to enable comprehensive financial modeling for Medicare Advantage plans, with specific provisions for scenarios involving plan changes and a focus on capturing all relevant financial inputs for rate calculation and proposal submission.
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Text version
Report Cover
| Exhibit 11: MAPD Rate Setting Support |
| [Supplier Name] |
| Plan Year [Year] |
| [Date] |
| Report | Report Title | Tab Name |
| 11a | MAPD Cost Proposal- No Proposed Benefit Changes | Cost Proposal |
| 11b | MAPD Rating Methodology- No Proposed Benefit Changes | Rating Methodology |
| 11c | MAPD Cost Proposal- With Proposed Benefit Changes | Cost Proposal- Changes |
| 11d | MAPD Rating Methodology- With Proposed Benefit Changes | Rating Methodology- Changes |
| Notes: | ||
| 1) If Supplier is offering an MAPD plan- 11a and 11b must be completed. | ||
| 2) If the Supplier is also proposing any plan changes, 11c and 11d must also be completed. |
11a Cost Proposal
| Request for Proposal: Medicare Plan Offering | |
| Fully Insured Pricing | No Plan Changes |
| For a fully-insured Medicare Advantage, please provide your pricing as indicated below: | |
| PEPM Rate (less ACA Insurance Industry Fee) | |
| ACA Insurance Industry Fee (if applicable) | |
| Total (PEPM Rate + ACA Insurance Fee) | $0.00 |
| For a fully-insured Medical Supplement plan, please provide pricing, including components below: | |
| PEPM Rate (less ACA Insurance Industry Fee) | |
| ACA Insurance Industry Fee (if applicable) | |
| Total (PEPM Rate + ACA Insurance Fee) | $0.00 |
&F &A &D &"Times New Roman,Italic"Aon Consulting
11b Rating Methodology
| Rating Methodology- No Plan Changes | ||
| Carrier: | ||
| Renewal Period: | ||
| Plan Option: | Medical | |
| Assumptions | ||
| Medical Claims Trend | ||
| Medical Management Adjustment | ||
| Other Adjustments | ||
| Risk Score | ||
| Claims | PMPM | |
| 1 | Total Medical Claims Cost | |
| 2 | Member Cost Sharing | |
| 3 | Total Plan Claims Cost (1-2) | $0.00 |
| Fixed Costs | ||
| 4 | Target Margin | |
| 5 | Administrative Costs | |
| 6 | State Premium Taxes | |
| 7 | Other Taxes/Fees | |
| 8 | Total Fixed Costs (4+5+6+7) | $0.00 |
| CMS Revenue | ||
| 9 | Plan Benchmark | |
| 10 | Plan Bid | |
| 11 | Rebate | |
| 12 | Quality Bonus Payments | |
| 13 | Total CMS Revenue | $0.00 |
| Group Medical Rate (3+8-13) | $0.00 |
| Pharmacy | ||
| Assumptions | ||
| Pharmacy Claims Trend | ||
| Other Adjustments | ||
| Risk Score | ||
| Gross Rx Plan Cost | PMPM | |
| 1 | Gross Rx Costs Net of AWP Discounts | |
| 2 | Member Cost Sharing | |
| 3 | Gross Rx Plan Cost Net of Member Cost Sharing (1 - 2) | $0.00 |
| Fixed Costs | ||
| 4 | Administrative Costs | |
| 5 | Other Taxes/Fees | |
| 6 | Projected Rebates | |
| 7 | Total Fixed Costs (4+5+6) | $0.00 |
| Revenue | ||
| 8 | Direct Capitation | |
| 9 | Manufacturer's Discount | |
| 10 | Fed Reinsurance | |
| 11 | Total Revenue (8+9+10) | $0.00 |
| Group PD Rate (3+7-11) | $0.00 |
2026 Group Rate $0.00
11c Cost Proposal- Changes
| Request for Proposal: Medicare Plan Offering | |
| Fully Insured Pricing | With Proposed Plan Changes |
| For a fully-insured Medicare Advantage, please provide your pricing as indicated below: | |
| PEPM Rate (less ACA Insurance Industry Fee) | |
| ACA Insurance Industry Fee (if applicable) | |
| Total (PEPM Rate + ACA Insurance Fee) | $0.00 |
| For a fully-insured Medical Supplement plan, please provide pricing, including components below: | |
| PEPM Rate (less ACA Insurance Industry Fee) | |
| ACA Insurance Industry Fee (if applicable) | |
| Total (PEPM Rate + ACA Insurance Fee) | $0.00 |
&F &A &D &"Times New Roman,Italic"Aon Consulting
11d Rating Methodology- Changes
| Rating Methodology- With Proposed Plan Changes | ||
| Carrier: | ||
| Renewal Period: | ||
| Plan Option: | Medical | |
| Assumptions | ||
| Medical Claims Trend | ||
| Medical Management Adjustment | ||
| Other Adjustments | ||
| Risk Score | ||
| Plan Design Change Factor | ||
| Claims | PMPM | |
| 1 | Total Medical Claims Cost | |
| 2 | Member Cost Sharing | |
| 3 | Total Plan Claims Cost (1-2) | $0.00 |
| Fixed Costs | ||
| 4 | Target Margin | |
| 5 | Administrative Costs | |
| 6 | State Premium Taxes | |
| 7 | Other Taxes/Fees | |
| 8 | Total Fixed Costs (4+5+6+7) | $0.00 |
| CMS Revenue | ||
| 9 | Plan Benchmark | |
| 10 | Plan Bid | |
| 11 | Rebate | |
| 12 | Quality Bonus Payments | |
| 13 | Total CMS Revenue | $0.00 |
| Group Medical Rate (3+8-13) | $0.00 |
| Pharmacy | ||
| Assumptions | ||
| Pharmacy Claims Trend | ||
| Other Adjustments | ||
| Risk Score | ||
| Plan Design Change Factor | ||
| Gross Rx Plan Cost | PMPM | |
| 1 | Gross Rx Costs Net of AWP Discounts | |
| 2 | Member Cost Sharing | |
| 3 | Gross Rx Plan Cost Net of Member Cost Sharing (1 - 2) | $0.00 |
| Fixed Costs | ||
| 4 | Administrative Costs | |
| 5 | Other Taxes/Fees | |
| 6 | Projected Rebates | |
| 7 | Total Fixed Costs (4+5+6) | $0.00 |
| Revenue | ||
| 8 | Direct Capitation | |
| 9 | Manufacturer's Discount | |
| 10 | Fed Reinsurance | |
| 11 | Total Revenue (8+9+10) | $0.00 |
| Group PD Rate (3+7-11) | $0.00 |
2026 Group Rate $0.00
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