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Group & Health Core Exam Old Group & Health Design & Pricing Forum

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  #131  
Old 11-01-2018, 07:40 PM
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Sredni Vashtar Sredni Vashtar is online now
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Quote:
Originally Posted by SnareSound View Post
I presumed that the SF group in the MLR question that it was just as it said: that was fees only. So you had to add claims to that for traditional denominator. Which is definitely claims / prems.
OH. Shoot. Must have skimmed right over that. Makes sense Darn.
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  #132  
Old 11-01-2018, 10:29 PM
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Anybody notice that the total and permanent disability problem didn’t give you a set of incidence rates to use for determining the premium? They directed you to use the census data of one company and the reserves for another, but didn’t give you any incidence rates. I ended up just assuming the rates from another part of the case study, but seems like yet another defective question...
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  #133  
Old 11-01-2018, 10:35 PM
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Actually, it is defined as benefit x reserve / 12 at least one spot in the source material.
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  #134  
Old 11-01-2018, 11:07 PM
xiaofan4 xiaofan4 is offline
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For the MLR Calc, did anyone add taxes to the given premiums for the standard MLR calculation? The premium was labeled "premium with commissions and fees" so I assumed it didn't include taxes.
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  #135  
Old 11-02-2018, 12:12 AM
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Quote:
Originally Posted by xiaofan4 View Post
For the MLR Calc, did anyone add taxes to the given premiums for the standard MLR calculation? The premium was labeled "premium with commissions and fees" so I assumed it didn't include taxes.
I subtracted taxes for both ACA and traditional MLR calc
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  #136  
Old 11-02-2018, 12:20 AM
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Do you guys remember those questions on asop?
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  #137  
Old 11-02-2018, 12:36 AM
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for the ACA MLR calculation, (clm+QI expense)/(Prem-tax&fees), do we use the premium in the first table, or we use the prem from the 1st table - the commission portion,
since the prem in the first table, the column title reads something like '(prem w commission fee included), which confused me....
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  #138  
Old 11-02-2018, 12:41 AM
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Originally Posted by GSUACT View Post
for the ACA MLR calculation, (clm+QI expense)/(Prem-tax&fees), do we use the premium in the first table, or we use the prem from the 1st table - the commission portion,
since the prem in the first table, the column title reads something like '(prem w commission fee included), which confused me....
I subtracted commissions, figured that's what the commissions table was there for. Did you all assume all the listed QI expenses were valid? Or excluded some? They all seemed to meet the QI definition to me so I included them all, although prob messed up on the PMPM vs. PMPY flip flops.
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  #139  
Old 11-02-2018, 04:34 AM
xiaofan4 xiaofan4 is offline
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I subtracted taxes for both ACA and traditional MLR calc
I don't think that's right. At the very least, one would include taxes, and one would exclude taxes from the denominator. Otherwise, why would the ACA MLR formula explicitly exclude taxes from the denominator?
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  #140  
Old 11-02-2018, 07:24 AM
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I don't think you'd subtract any from traditional. Also, I had this feeling we should not be reducing for federal taxes (only state and local) and left them in. I'm not sure about that part. Also, I did not think every item in that list was QI and left at least a couple off that list out.
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