Exhibit_6_HMO_Rate_Development.xlsx

XLSX spreadsheet 31 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

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The file is an Excel spreadsheet titled "Exhibit 6: HMO Rate Development" used for healthcare rate calculations and bidding purposes. The document provides two worksheets: 6a for HMO rate development with no plan changes (required for all bidders) and 6b for HMO rate development with proposed plan changes (for returning suppliers proposing modifications). The spreadsheet is designed to capture detailed financial and enrollment data for health insurance rate calculation, including subscriber totals, member counts, premium calculations, claims forecasts, and current plan year premium rates.

The rate development exhibit enables bidders to document key financial metrics such as incurred claims, Rx rebates, pooled claims, trend factors, retention costs, and various healthcare-related fees (PCORI, Health Insurer Fee, State Taxes). The document requires comprehensive data across multiple categories, including enrollment demographics (employee only, spouse, child coverage), monthly premium rates, and percentage increases. Notably, the spreadsheet includes provisions for supplemental explanations from actuaries regarding claims methodology, particularly for organizations with indirect rebate credit processes, indicating a thorough approach to rate development and transparency in healthcare insurance pricing.

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Report Cover

Exhibit 6: HMO Rate Development
[Supplier Name]
[Date]
ReportReport TitleTab Name
6aHMO Rate Development- No Plan ChangesNo Plan Changes
6bHMO Rate Development- With Proposed Plan ChangesWith Proposed Plan Changes
Notes:
1) HMO Rate Development- 6a No Plan Changes must be completed by all Bidders.
2) If the Bidder is a returning Supplier and is also proposing any plan changes, 6b HMO Rate Development- With Proposed Plan Changes must also be completed.

6a No Plan Changes HMO Rate Development- No Plan Changes Plan Year [Year] Note: Information requested on a per member per month (pmpm) basis should reflect the total membership applicable.

Rate Development
MedicalRxCapitationTotal
I. Financial Data
A.Total Subscriber
B.Total Members
C.Age Factor/ Sex Factor
D.Total Premium
E.Total Paid Claims/Net of Rebates
H.Paid Loss Ratio
II.Claims Forecast
A.Incurred Claims (12/16)
B.Less: Rx Rebates (1)
C.Less Pooled Claims
a)Pooling Level Used
D.Pooling Charge
E.IBNR
F.------
G.Estimated Incurred Claims
H.Exposure Units - Member Months
I.Estimated Incurred Claims PMPM
Trend Factor
Annual Trend % Used:
J.Expected Claims PMPM
K.Retention PMPM
L.Retention - EGID @ $4.477 PMPM
M.PPACA - PCORI PMPM
N.PPACA - Health Insurer Fee PMPM
O.State Taxes PMPM
P.Projected Premium PMPM
Q.Current Premium PMPM
R.Percentage Increase
III.Average of Current Play Year Enrollment
A.Employee Only
B.Spouse
C.Child
D.Child(ren)
E.Spouse + Child (= B. + C.)
F.Spouse + Children (= B. + D.)
IV.Current Plan Year Monthly Premium Rates
A.Employee Only
B.Spouse
C.Child
D.Children
E.Total Premium (See Note 2)
Notes: (1) If your organization does not provide a direct credit for claims, please provide a supplemental explanation (signed by an Actuary) detailing how, and in what amounts, rebates are accounted for in your methodology.
(2)= [(III.A x IV.A) + (III.B. x IV.B.) +( III.C. x IV.C.) + (III.D x IV.D.)]*12
CONFIDENTIAL

6b With Proposed Plan Changes HMO Rate Development- With Proposed Plan Changes Plan Year [Year] Note: Information requested on a per member per month (pmpm) basis should reflect the total membership applicable.

Rate Development
MedicalRxCapitationTotal
I. Financial Data
A.Total Subscriber
B.Total Members
C.Age Factor/ Sex Factor
D.Total Premium
E.Total Paid Claims/Net of Rebates
H.Paid Loss Ratio
II.Claims Forecast
A.Incurred Claims (12/16)
B.Less: Rx Rebates (1)
C.Less Pooled Claims
a)Pooling Level Used
D.Pooling Charge
E.IBNR
F.Plan Design Changes
G.Estimated Incurred Claims
H.Exposure Units - Member Months
I.Estimated Incurred Claims PMPM
Trend Factor
Annual Trend % Used:
J.Expected Claims PMPM
K.Retention PMPM
L.Retention - EGID @ $4.477 PMPM
M.PPACA - PCORI PMPM
N.PPACA - Health Insurer Fee PMPM
O.State Taxes PMPM
P.Projected Premium PMPM
Q.Current Premium PMPM
R.Percentage Increase
III.Average of Current Play Year Enrollment
A.Employee Only
B.Spouse
C.Child
D.Child(ren)
E.Spouse + Child (= B. + C.)
F.Spouse + Children (= B. + D.)
IV.Current Plan Year Monthly Premium Rates
A.Employee Only
B.Spouse
C.Child
D.Children
E.Total Premium (See Note 2)
Notes: (1) If your organization does not provide a direct credit for claims, please provide a supplemental explanation (signed by an Actuary) detailing how, and in what amounts, rebates are accounted for in your methodology.
(2)= [(III.A x IV.A) + (III.B. x IV.B.) +( III.C. x IV.C.) + (III.D x IV.D.)]*12
CONFIDENTIAL

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