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  #51  
Old 11-28-2013, 08:50 PM
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Am I correct to assume IP/OP rehab isn't covered by the HMO plan?
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  #52  
Old 12-14-2013, 02:16 AM
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Quote:
Originally Posted by colby2152 View Post
Am I correct to assume IP/OP rehab isn't covered by the HMO plan?
Based on the plan design I would assume that's covered under SCP.
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  #53  
Old 12-21-2013, 11:34 PM
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I definitely agree with the people who say that the manual rate should be extracted from the module. The plan design modeler also appeared in the module (although a couple inputs were slightly different), and the net cost from the module modeler did not equal the manual PMPM.

But clearly people have passed using different things for the manual PMPM, so I guess it doesn't really matter.
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Old 02-07-2014, 11:16 PM
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Are people not adjusting their PMPMs by the benefit factors?
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  #55  
Old 02-15-2014, 01:45 PM
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I adjusted the prior company experience for the new plan design, and I adjusted the manual rate for the new plan design (since the chosen plan design was different from the design assumed in the manual rate).

Is that what you're talking about, or are you referring to something else? There are places earlier in this thread where people talk about adjusting for benefits, so maybe I'm misunderstanding your question.
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  #56  
Old 02-22-2014, 03:37 PM
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Originally Posted by Sir Deicide View Post
Yeah, I'm not so sure about those earlier posts. The HMO high net cost does not seem to be the manual net cost. We don't know what the experience period is, we don't know if provider discounts have changed, and the copay assumptions are variable. Based on the case study, it seems that the 2011 manual rate should be used. I think the HMO high exhibit is strictly for plan factor development.

$244 is high. Don't forget the benefit factor.
This seems way too high to me. Is anyone else getting something this large for the manual premium rate PMPM?
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  #57  
Old 02-22-2014, 08:33 PM
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My manual claims PMPM was way lower than that. It was around $170 (claims, not premium). I think that's consistent with others in this thread.
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  #58  
Old 02-23-2014, 10:45 AM
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My manual claims PMPM was way lower than that. It was around $170 (claims, not premium). I think that's consistent with others in this thread.
Yeah, I am ending up with a manual claim cost PMPM of $175.67. Overall total premium PMPM of $206.92.
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Old 05-22-2014, 02:07 PM
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I got:

Experience premium 186.23*.8568(benefit)*1.11(trend)/.85(LR)=208.36
Manual rate 256.96(given)*.7878(benefit)*.95(size)=192.32

Am I close?
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  #60  
Old 07-24-2014, 09:48 PM
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Quote:
Originally Posted by mathmajor View Post
I got:

Experience premium 186.23*.8568(benefit)*1.11(trend)/.85(LR)=208.36
Manual rate 256.96(given)*.7878(benefit)*.95(size)=192.32

Am I close?
mathmajor, where are you getting 256.96? The HMO high P0002 net claim PMPM I see given is $177.33. Consequently I'm getting a much lower manual claim PMPM. Has the exercise changed in the last 2 months?
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