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Old 05-31-2019, 11:06 AM
AlexLar2007 AlexLar2007 is offline
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Default Section 3: Plan Designs HMO to PPO

I think the solution on the CS Pricing HMO to PPO spreadsheet, Tab6-PPO has the following errors:

1) Out-of-network Gross PMPM is equal to that of the in-network: $574.76. This implies that network discounts are the same for both models, even though pdf doc explicitly states that the out-of-network model gets no network discount.

2) Pharmacy costs seem to be double-counted. First, they are included in the initial gross PMPM cost of $574.61. Later, they added again to come up with the total PMPM net claims cost.

Did anyone else notice these errors?
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Old 05-31-2019, 11:26 AM
career changer 2 career changer 2 is offline
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Are you on an older version of the module? My section 3 was about LTC pricing.
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Old 05-31-2019, 12:04 PM
AlexLar2007 AlexLar2007 is offline
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I purchased the module back in August 2018.
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Old 05-31-2019, 03:50 PM
cpfortenberry cpfortenberry is offline
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I’m assuming the question is about the contents of the module, not the EOM. Is that right?
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Old 05-31-2019, 03:57 PM
cpfortenberry cpfortenberry is offline
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Your observations appear to be correct. I didn’t catch those the first time through. The two pharmacy claim costs are slightly different though. One is gross of cost sharing and the other is net.
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