filing at a glance · cbc’s data warehouse. the method for calculating incurred claims in the bep...

Filing at a Glance

Company: Capital Advantage Assurance Company

Product Name: Rates - CAAC Individual Transitional PPO

State: Pennsylvania

TOI: H16I Individual Health - Major Medical

Sub-TOI: H16I.005A Individual - Preferred Provider (PPO)

Filing Type: Rate - G.I. (Guaranteed Issue)

Date Submitted: 08/14/2019

SERFF Tr Num: CABC-132041593

SERFF Status: Assigned

State Tr Num: CABC-132041593

State Status: Received Review in Progress

Co Tr Num: 19-81

ImplementationDate Requested:

01/01/2020

Author(s): Anna Fulginiti, Mary Leberknight, Kayla Sokolas

Reviewer(s): Rashmi Mathur (primary)

Disposition Date:

Disposition Status:

Implementation Date:

State Filing Description:

SERFF Tracking #: CABC-132041593 State Tracking #: CABC-132041593 Company Tracking #: 19-81

State: Pennsylvania Filing Company: Capital Advantage Assurance Company

TOI/Sub-TOI: H16I Individual Health - Major Medical/H16I.005A Individual - Preferred Provider (PPO)


Project Name/Number: /

PDF Pipeline for SERFF Tracking Number CABC-132041593 Generated 08/19/2019 01:07 PM

General Information

Company and Contact

Filing Fees

Project Name: Status of Filing in Domicile:

Project Number: Date Approved in Domicile:

Requested Filing Mode: Review & Approval Domicile Status Comments:

Explanation for Combination/Other: Market Type: Individual

Submission Type: New Submission Individual Market Type: Individual

Overall Rate Impact: Filing Status Changed: 08/14/2019

State Status Changed: 08/15/2019

Deemer Date: Created By: Mary Leberknight

Submitted By: Mary Leberknight Corresponding Filing Tracking Number: CABC-131142496;CABC-131157049; CABC-131157394; CABC-131157390

State TOI: H16I Individual Health - Major Medical

State Sub-TOI: H16I.005A Individual - Preferred Provider(PPO)

PPACA: Not PPACA-Related

PPACA Notes: null

Include Exchange Intentions: No

Additional Benefits: No

Filing Description:

Rates CAAC Individual Transitional PPO (PersonalBlue)

Filing Contact InformationStephanie Gray, Manager ActuarialServices

[email protected]

2500 Elmerton Avenue

Harrisburg, PA 17110

717-541-7269 [Phone]

Filing Company InformationCapital Advantage AssuranceCompany

2500 Elmerton Avenue

Harrisburg, PA 17110

(717) 541-7000 ext. [Phone]

CoCode: 14411

Group Code:

Group Name:

FEIN Number: 45-5492167

State of Domicile:Pennsylvania

Company Type: LAH

State ID Number:

Fee Required? No

Retaliatory? No

Fee Explanation:







Rate Information Rate data applies to filing.

Filing Method: Review & Approval

Rate Change Type: Increase

Overall Percentage of Last Rate Revision: 30.000%

Effective Date of Last Rate Revision: 01/01/2018

Filing Method of Last Filing: Review & Approval

SERFF Tracking Number of Last Filing: CABC-131157380

Company Rate Information

Company

Name:

Company

Rate

Change:

Overall %

Indicated

Change:

Overall %

Rate

Impact:

Written

Premium

Change for

this Program:

Number of Policy

Holders Affected

for this Program:

Written

Premium for

this Program:

Maximum %

Change

(where req'd):

Minimum %

Change

(where req'd):

Capital AdvantageAssurance Company

Increase 14.500% 14.500% $1,500,042 3,112 $10,345,118 14.500% 14.500%







Rate Review Detail

COMPANY:Company Name: Capital Advantage Assurance Company

HHS Issuer Id: 45127

PRODUCTS:

Product Name HIOS Product ID HIOS Submission ID Number of Covered

LivesCAAC Individual Transitional PPO 3112

Trend Factors:

FORMS:New Policy Forms: n/a

Affected Forms: n/a

Other Affected Forms: n/a

REQUESTED RATE CHANGE INFORMATION:Change Period: Annual

Member Months: 0

Benefit Change: None

Percent Change Requested: Min: 0.0 Max: 0.0 Avg: 0.0

PRIOR RATE:Total Earned Premium: 0.00

Total Incurred Claims: 0.00

Annual $: Min: 0.00 Max: 0.00 Avg: 0.00

REQUESTED RATE:Projected Earned Premium: 0.00

Projected Incurred Claims: 0.00

Annual $: Min: 0.00 Max: 0.00 Avg: 0.00







Rate/Rule Schedule

Item

No.

Schedule

Item

Status

Document Name

Affected Form Numbers

(Separated with commas) Rate Action Rate Action Information Attachments

1 Rate Rule New Ind_19_81_Initial_CAAC_MUW-GI-PPO_Rates_RateRule_20190805.xlsx,







Attachment Ind_19_81_Initial_CAAC_MUW-GI-PPO_Rates_RateRule_20190805.xlsx is not a PDFdocument and cannot be reproduced here.







Supporting Document Schedules Satisfied - Item: Transmittal Letter (A&H)Comments:Attachment(s): Ind_19_81_Initial_CAAC_MUW-GI-PPO_RateCvLtr_Supporting_20190805.pdfItem Status:Status Date:

Satisfied - Item: Actuarial Memorandum and Explanatory Information (A&H)Comments:

Attachment(s): Ind_19_81_Initial_CAAC_MUW-GI-PPO_ActMemo_Supporting_20190805.pdfInd_19_81_Initial_CAAC_MUW-GI-PPO_RateDev_Supporting_20190805.pdf

Item Status:Status Date:







August 5, 2019

Ms. Tracie Gray, Director Bureau of Life, Accident and Health Insurance Office of Insurance Product Regulation and Administration Commonwealth of Pennsylvania Insurance Department 1311 Strawberry Square Harrisburg, PA 17120

Re: Capital Advantage Assurance Company Individual Transitional PPO

Filing No 19-81 TOI Code: H161 Individual Health – Major Medical Sub-TOI Code: H161.005A Individual Preferred Provider Filing Type: Rate

Dear Ms. Gray: By this filing Capital BlueCross, on behalf of its wholly owned subsidiary Capital Advantage Assurance Company, submits to the Department Individual Transitional Rates effective January 1, 2020. The following is a summary of the rate filing:

Company Name: Capital Advantage Assurance Company (CAAC) NAIC: 14411 Market: Individual Effective Date: 1/1/2020 Average Rate Change: 14.5% Min/Max Rate Change: 14.5%/14.5% Product: PPO Current Covered Lives: 3,112 Rate Filing: CABC-132041593 Form Filings:

o CABC-132023973 o CABC-132023919 o CABC-132023901 o CABC-132023867

In support of this filing, I have included an actuarial memorandum with supporting exhibits, rate tables, and the Rate Review Justification template.

If you have any questions regarding this filing, please call me at 717-541-7269 (or via email at [email protected]) or Mark Spitler at 717-541-6613 ([email protected]). Thank you for your assistance in this matter. Sincerely, Stephanie Gray, ASA, MAAA Manager, Actuarial Services Capital BlueCross Enclosures cc: Mark Spitler, FSA, MAAA, Senior Director, Actuarial Services

Mell McKelvey, ASA, MAAA, Vice President and Chief Actuary, Actuarial Services Todd Shamash, Corporate Counsel

mailto:[email protected]


hbc0905

Stephanie

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Capital Advantage Assurance Company Individual Transitional Rates

January 1, 2020 Filing 19-81

Actuarial Memorandum

Background On November 14, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a letter to the State Insurance Commissioners outlining a transitional policy for non-grandfathered coverage in the individual and small group health insurance markets for policies effective January 1, 2014. The transitional policy stated that policies subject to transitional relief are not considered to be out of compliance with the following provisions of the Public Health Service Act (PHS Act):

• Section 2701 (relating to fair health insurance premiums);

• Section 2702 (relating to guaranteed availability of coverage);

• Section 2703 (relating to guaranteed renewability of coverage);

• Section 2704 (relating to the prohibition of pre-existing condition exclusions or other discrimination based on health status), with respect to adults, except with respect to group coverage;

• Section 2705 (relating to the prohibition of discrimination against individual participants and beneficiaries based on health status), except with respect to group coverage;

• Section 2706 (relating to non-discrimination in health care);

• Section 2707 (relating to comprehensive health insurance coverage);

• Section 2709, as codified at 42 U.S.C. § 300gg-8 (relating to coverage for individuals participating in approved clinical trials).

On March 25, 2019, the Centers for Medicare and Medicaid Services (CMS) announced that they will extend their transitional policy to plan years beginning on or before October 1, 2020, provided that all such plans end by December 31, 2020. Under this federal transitional policy, health insurance issuers may choose to continue certain non-grandfathered coverage in the individual and small group health insurance markets that would otherwise be cancelled, and affected individuals and small businesses may choose to re-enroll in such coverage. As noted in the federal guidance, policies subject to the transitional relief are not considered to be out of compliance with certain provisions of the Public Health Service Act and the Affordable Care Act.

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Scope and Purpose By this filing, in accordance with Act 134 and the Affordable Care Act (ACA) transitional policy, Capital Advantage Assurance Company (CAAC), a subsidiary of Capital BlueCross (CBC), submits rates for transitional members effective January 1, 2020. Company Contact Information

Primary Contact Name: Stephanie Gray Primary Contact Telephone Number: (717) 541 – 7269 Primary Contact Email Address: [email protected]

Proposed Rates CAAC is proposing an aggregate annual 14.5% rate increase. The rate change does not vary by plan. Experience Period Claims Base Experience Period: The base experience period (BEP) includes completed fee-for-service paid and incurred claims for dates of service between January 1, 2018 and December 31, 2018. Paid Through Date: Claims in the BEP are paid through June 30, 2019 Estimated Incurred but Not Paid Claims: Paid claims by date of service come directly from CBC’s data warehouse. The method for calculating incurred claims in the BEP is as follows:

1. Historical fee-for-service claims are viewed by date of service and date of payment in a claims triangle.

2. The claims triangle payments are then accumulated by date of service to develop factors that represent the rate of accumulation or rate of “completion”.

3. Historical rates of completion by duration are used to derive projected rates of completion. Some of the methods used to develop projected completion factors are averages (e.g. harmonic averages, time weighted averages, geometric averages) and regression methods. Numerous items are considered when viewing these averages or regression statistics, such as the impact of high claims on perceived completion patterns.

4. For durations that exhibit a projected completion factor greater than the Valuation Actuary’s chosen threshold (e.g. 80% complete), cumulative paid and incurred claims are divided by the projected completion factor to arrive at ultimate incurred claims. For durations that are less than the chosen threshold, a projection methodology is used. Similar to completion factor development, projection methodologies are worthy of a lengthy discussion. In general, an ultimate incurred claims PMPM is derived by projecting a recent 12-month period to the current month(s) and seasonally adjusting.

5. With all months having both a cumulative paid amount and an estimated ultimate incurred amount, the completion factors used in pricing are calculated by taking the


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quotient of the two. Allowed completion and incurred completion are assumed to be identical.

6. Both allowed and paid claims in the BEP are completed by applying completion factors by incurred month developed in Step 6.

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= �� + �� ℎ�� ℎ

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Rx Rebates: Prescription drug claims are net of Rx rebates. Capitated Services: There are no capitated services attributable to this segment. Projection Factors Trend Factors: Trend levels reflect CBC’s best estimate of changes in utilization, provider reimbursement contracts, the network of facilities and providers, disease management initiatives and the impact of utilization management. The following is a description of considerations used to determine trend.

1. Base Cost/ Change in hospital and physician contracting: The contracted increase in reimbursements to hospitals and physicians is the basis of cost trends. CBC uses the following to project future costs:

a. Vendor Physician Cost Model and Internal Hospital Contracting Model

i. The medical cost models use best estimates of Capital BlueCross (CBC)’s future contracting increases with physicians and hospitals. The models use cost estimates based on varying contract effective dates by physician and hospital. All facilities and providers are considered in this modeling effort (i.e. acute and non-acute, network and non-network, inpatient and outpatient, in- area and out-of-area). From there, a monthly anticipated cost (assuming static utilization) summary is produced which can be used in projecting future claims costs. Cost trends are determined at the CBC book of business level for all commercial business.

b. Internal Prescription Drug Trend Model i. Price Inflation

ii. Contract Pricing iii. Member Cost-Sharing iv. Units per Script v. Brand/Generic Mix

vi. Therapeutic Mix

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vii. Cost per Script viii. Pipeline (new drugs)

2. Utilization Considerations:

a. Intensity of medical services rendered b. Changes in place of service (e.g. continued migration of inpatient stays to

outpatient setting) c. Further migration from brand prescription drugs to generic prescription drugs d. Favorable impacts of value based benefits designs e. Medical utilization estimates reviewed by CBC’s Chief Medical Officer

3. Leveraging: The trend model is based on allowed cost increases. Paid claims trend at a

higher rate than allowed due to leveraging. Leveraging is the impact of static cost-share, such as deductibles and copays, to the paid trend.

4. Intensity: Measure of cost increase due to change in treatment sophistication. An

example is migration from x-rays to MRIs at significantly higher cost.

5. Underwriting Cycle: The underwriting cycle is defined as the tendency to swing between profitable and unprofitable periods over time. The underwriting cycle is exacerbated partly by pricing performed with incomplete information as to the level of current experience trends. A reaction delay occurs, as carriers tend to rely on measurements of past experience in developing current pricing assumptions. As a result, carriers are often increasing their pricing trends when actual experience trends have begun to decline, and decreasing their pricing trends actual trends are increasing. CBC strives to mitigate the underwriting cycle by keeping trends consistent through times of increasing and decreasing claim cost and utilization.

Please see Exhibit A – Trend for all trend values. Cost and Utilization trend values are taken directly from 1/1/2020 Individual CAAC filing (CABC-131915676), as CBC expects future costs to follow a similar pattern. Weights are applied based on BEP transitional claims by claim type as displayed in the Rate Review Justification template. Please note Exhibit A1 showing Individual transitional historical trends, which are running significantly higher than pricing trends. This leads into the morbidity discussion directly below. Morbidity Adjustment: A morbidity factor is applied to trend to account for the wear off of medical underwriting at inception, at least 5 years ago. Exhibit A2 shows the 12-month rolling loss ratio and claim PMPM for this stable enrolled population. Just in the last 4 months, 12-month claim PMPMs have increased 6%. 2% is added to trend per year, for a total adjustment of 4%. Benefit Adjustment: No benefit adjustment is applied as the benefits in the projection period are the same as those in the BEP.

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Non-Benefit Expenses and Profit & Risk Administrative Expense Load:

1. Administrative Expense: Calculated using an allocation method from CAAC’s finance department, and trended to the rating period. Costs are allocated according to results reported through a company-wide questionnaire. On an annual basis, each cost center within the company completes a questionnaire listing the distribution of costs (in percentage terms) by product as well as by market segment. For example, the questionnaire will ask what percentage of time is spent on PPO versus HMO versus Drug versus Medicare. And separately will ask what percentage of time is spent on large group, small group, individual, and government programs. Using those distributions, all costs needed to perform the business are allocated to the proper market segments and lines of business. The administrative expense applied in the rate development is the total expense allocated to CAAC medically-underwritten individual products.

2. Broker Expense: CAAC’s transitional YTD 2019 broker fee PMPM. 3. Identity Theft Coverage: Identity protection offering will include the following

components: a. Credit monitoring – Monitors activity that may affect credit b. Fraud detection – Identifies potentially fraudulent use of identity or credit c. Fraud resolution support – Assists members in addressing issues that arise in

relation to credit monitoring and fraud detection Profit (or Contribution to Surplus) & Risk Margin:

4. Contingency Taxes and Fees:

1. Health Insurer Fee (HIF) – Section 9010 of PPACA and Section 1406 of the

Reconciliation Act (which modified PPACA) refer to HIF. The fee is a fixed-dollar amount distributed across health insurance providers: $8 billion in 2014, $11.3 billion in 2015-2016, suspended in 2017, $14.3 billion in 2018, moratorium in 2019, and reinstated in 2020. The fee applied is equal to that calculated in 1/1/2020 Individual CAAC filing (CABC-131915676).

2. Premium Tax: Premium tax does not apply to CAAC.

Please see Exhibit B – Retention for all retention values. Rate Development Projected Paid and Incurred Claims are calculated as follows:

1. Gather claims experience as described in the Data section above. a. Base Experience Period (BEP) Paid Claims, Capitation, and Rx Rebates

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b. BEP Member Months

2. Develop BEP Paid and Incurred Claims:

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The development of completion factors is described in Experience Period Premium and Claims above.

3. Develop the BEP Paid and Incurred Claim PMPM:

�� =��

�� ℎ�

4. Develop Trended Claim PMPM: Using the aggregate trend described in the Projection Factors section above, trend the BEP Paid and Incurred Claim PMPM from the midpoint of the experience period to the midpoint of the rating period.

��

= [�� ]

× (1 + [��%])�� /��

5. Develop Projected Paid and Incurred Claim PMPM:

�� = [�� ] × [�� ] × [�� ]

The Benefit Adjustment and Morbidity Adjustment are discussed in the Projections Factors section above.

6. Develop Adjusted Projected Paid and Incurred Claim PMPM for capitation and Rx rebates.

�� = [�� ]+ [�� ] + [�� ]

7. Develop Total Required Premium PMPM:

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=

[�� ] + [�� ] + [�� ]

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1 − [��%] − [�� %] − [��%]

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Admin PMPM, Broker PMPM, Identity Theft, Health Insurer Fee (HIF), Premium Tax, and Contingency development are described in the Non-Benefit Expenses and Profit & Risk section above.

8. Develop Total Recommended Base Rate Premium PMPM: The Recommended Base Rate Premium PMPM is CAAC’s final recommendation based on actuarial analysis.

The development of Total Recommended Base Rate Premium is shown in Exhibit C – Rate Development. Attachments and Exhibits Rates: File: Ind_19-81_Initial_CAAC_MUW-GI-PPO_Rates_RateRule_20190805.xlsm Rate Development: File: Ind_19-81_Initial_CAAC_MUW-GI-PPO_RateDev_Supporting_20190805.xlsm

Exhibit A – Trend Exhibit A1 – Historical Trends Exhibit A2 - Morbidity Exhibit B - Retention Exhibit C – Rate Development

Rate Review Justification: File: Ind_19-81_Initial_CAAC_MUW-GI-PPO_RRJ_Supporting_20190805.xlsm Actuarial Statement I, Stephanie Gray, ASA, MAAA, am of the opinion that this filing is in compliance with the applicable Federal and State Laws and Regulations concerning the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. I, Stephanie Gray, ASA, MAAA, do hereby certify that:

1. This filing has been prepared in accordance with the following: a. Actuarial Standard of Practice No. 5, “Health and Disability Claims” b. Actuarial Standard of Practice No. 8, “Regulatory Filings for Rates and

Financial Projections for Health Plans” c. Actuarial Standard of Practice No. 12, “Risk Classification” d. Actuarial Standard of Practice No. 23, “Data Quality” e. Actuarial Standard of Practice No. 25, “Credibility Procedures Applicable to

Accident and Health, Group Term Life, and Property/Casualty Coverage” f. Actuarial Standard of Practice No. 26, “Compliance with Statutory and

Regulatory Requirements for the Actuarial Certification of Small Employer Health Benefit Plans”

g. Actuarial Standard of Practice No. 41, “Actuarial Communications”.

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2. This filing contains all requirements listed under CMS preliminary justification Part I, Part II, and Part III.

Stephanie Gray, A.S.A., M.A.A.A.

hbc0905

Stephanie

Exhibit A_Trend

Category Cost Utilization Morbidity Total Weights Total Weights

Inpatient Hospital 6.0% 2.3% 2.0% 10.6% 19% 17%

Outpatient Hospital 5.7% 2.3% 2.0% 10.2% 51% 46%

Professional 3.9% 1.8% 2.0% 7.8% 28% 25%

Other Medical 5.7% 2.0% 2.0% 9.9% 2% 2%

Capitation 3.0% 0.0% 2.0% 5.1% 0% 0%

Prescription Drug 8.8% 0.9% 2.0% 11.9% 100% 10%

Total 9.9%

Medical 9.6%

Drug 11.9%

Total 100.0%

Utilization 20.5%

Cost 77.5%

Other 2.0%

% Impact

Aggregate Pricing Trend

Capital Advantage Assurance Company

Individual Transitional Rates

1/1/2020

Trend

Trend by Service Category

Filing 17-89 1 8/5/2019

Allowed PMPM 201903 201803 201703 2019/2018 2018/2017

Inpatient 55.35$ 37.46$ 40.30$ 47.7% -7.0%

Outpatient 134.39 111.08 112.69 21.0% -1.4%

Professional 76.98 65.05 66.21 18.4% -1.8%

Medical Total 266.72$ 213.59$ 219.21$ 24.9% -2.6%

Non-Specialty Drug 25.44 24.93 24.36 2.0% 2.3%

Specialty Drug 12.63 10.14 7.80 24.5% 30.1%

Pharmacy Total 38.07$ 35.07$ 32.16$ 8.5% 9.1%

Grand Total 304.78$ 248.66$ 251.36$ 22.6% -1.1%

Incurred/Paid PMPM

Inpatient 52.14$ 34.09$ 37.33$ 52.9% -8.7%

Outpatient 103.69 84.76 87.04 22.3% -2.6%

Professional 51.51 40.30 42.32 27.8% -4.8%

Medical Total 207.33$ 159.16$ 166.69$ 30.3% -4.5%

Non-Specialty Drug 16.39 15.29 13.81 7.2% 10.7%

Specialty Drug 12.22 9.87 7.41 23.9% 33.2%

Pharmacy Total 28.61$ 25.16$ 21.22$ 13.7% 18.6%

Grand Total 235.94$ 184.31$ 187.91$ 28.0% -1.9%

Utilization Metrics

Admissions/1000 Members 21.7 19.7 21.1 9.7% -6.3%

Average Length of Stay 3.73 3.53 4.14 5.8% -14.7%

Days/1000 Members 81 70 87 16.0% -20.1%

Outpatient Visits/1000 Members 1,492 1,348 1,380 10.7% -2.3%

Professional Visits/1000 Members 5,521 5,195 5,307 6.3% -2.1%

Non-Specialty Prescriptions PMPY 7.65 7.42 7.18 3.1% 3.3%

Specialty Prescriptions PMPY 0.023 0.019 0.018 24.3% 4.9%

12 Months Ended: % Change



1/1/2020

Historical Trend

For 12 Month Periods Ended 201903

Date Claims* Revenue Enrollment 12-Month LR

12-Month

Claim

PMPM

Change in

Morbidity

Applied in

Trend201801 $717,350 $1,059,828 3,825

201802 $496,333 $1,045,461 3,784

201803 $694,808 $1,030,104 3,740

201804 $690,501 $1,016,169 3,694

201805 $867,410 $1,001,070 3,646

201806 $678,480 $991,352 3,607

201807 $555,298 $976,708 3,568

201808 $880,915 $967,552 3,540

201809 $1,105,249 $955,178 3,505

201810 $857,128 $937,381 3,447

201811 $742,072 $921,008 3,396

201812 $1,120,528 $908,687 3,362 80% $218.17

201901 $700,082 $908,588 3,261 81% $220.65

201902 $660,347 $898,482 3,225 83% $227.50

201903 $748,797 $887,636 3,186 84% $231.84 1.06 1.02

*Incurred Medical and Rx Claims Net Rebates. Valuation Date 201905

While 6% is seen in recent months, 2% is added to trend over 2 years, for total of 4%



1/1/2020

Morbidity

Exhibit B_Ret

Description Amount

Admin PMPM $34.86

Broker PMPM $3.61

BCBSA Identity Theft Protection $0.02

Patient-Centered Outcomes Research Trust Fund: $0.00

Insurer Tax 2.89%

Premium Tax 0.0%

Contingency 2.0%



1/1/2020

Retention

Filing 17-89 5 8/5/2019

Exhibit C_RateDev

Base Experience Period: 01/01/2018 - 12/31/2018 Base Experience Period: 01/01/2018 - 12/31/2018

Data as of 6/30/2019 Data as of 6/30/2019

Rating Period: 01/01/2020 - 12/31/2020 Rating Period: 01/01/2020 - 12/31/2020

Trend Months: 24 Trend Months: 24

Trend: 9.6% Trend: 11.9%

1 Medical Paid and Incurred Claims 8,461,656 1 BEP Paid and Incurred Claims 1,059,105

2 Completion Factor 0.99 2 Completion Factor 1.000

3 BEP Completed Claims (1) / (2) 8,504,541 3 BEP Completed Claims (1) / (2) 1,059,105

4 BEP Member Months 43,114 4 BEP Member Months 43,114

5 BEP Completed Claim PMPM (3) / (4) 197.26 5 BEP Completed Claim PMPM (3) / (4) 24.57

6 Trend Factor 1.20 6 Trend Factor 1.25

7 Trended Claim PMPM (5) x (6) 237.08 7 Trended Claim PMPM (5) x (6) 30.77

8 Morbity Adjustment (Note Morbidity Adj is applied in trend) 1.00 8 Morbity Adjustment (Note Morbidity Adj is applied in trend) 1.00

9 Benefit Adjustment 1.0 9 Benefit Adjustment 1.0

10 Capitation 0 10 Rx Rebates 153,440

11 Capitation PMPM 0.00 11 Rx Rebates PMPM 3.56

12 Total Benefit Adjusted Claim PMPM (7) x (8) x (9) + (11) 237.08 12 Total Benefit Adjusted Claim PMPM (7) x (8) x (9) + (11) 27.21

13 Admin $33.62 13 Admin $1.24

14 Broker $3.61 14 Broker $0.00

15 BCBSA Identity Theft Protection $0.02 15 BCBSA Identity Theft Protection $0.00

16 Patient-Centered Outcomes Research Trust Fund: $0.00 16 Patient-Centered Outcomes Research Trust Fund: $0.00

17 Health Insurer Tax 2.89% 17 Health Insurer Tax 2.89%

18 Premium Tax 0.0% 18 Premium Tax 0.0%

19 Contingency 2.0% 19 Contingency 2.0%

20 Required Premium $288.45 20 $29.91

21 Current Premium $239.63 21 $38.41

22 Required Increase 20.4% 22 -22.1%

23 Total Required Rate Change 14.5%

24 Total Proposed Rate Change 14.5%

Medical Claims Rate Development Drug Claims Rate Development



1/1/2020

Rate Development

Filing 17-89 6 8/5/2019

filing at a glance · cbc’s data warehouse. the method for calculating incurred claims in the bep...

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