Scoring & Metrics for Fully Insured Groups Defining Scoring & Metrics
Manual
Industry (varies by vendor) loss ratio prediction factor.
This is a scalar score encompassing the age, gender, and geographic weights associated with every health insurance manual. The manual is generally understood as a factor that can be multiplied by a base rate to assign the partial manual rate to individuals and groups.
Example: Age * Gender * Geography = 1.03
Example Health Manuals:
• HealthMAPS (Tillinghast)
• Windsor
• Custom Age/Gender/Zip5
Manual +
Verikai loss ratio prediction factor.
Manual+ is a factor at both the group and individual level, providing insight into the first-dollar claiming experience expected to occur over the following 12 months. Normalized on the experience of over 10,000,000 members with 100% loss ratio at 70% Rate to Manual (RTM), Manual+ is the predicted loss ratio of the individual or group prior to subjective underwriting discounts and retention (additional variables you would add on such as additional taxes, fees, TPA, marketing broker fees, etc.).
Example: 0.65
Interpretation: 65% expected loss ratio prior to subjective retention.
Claims +
Verikai adjusted Age, Gender, and Geography manual factor.
Claims+ is the adjusted base manual factor at both the group and individual level, providing insight into the first-dollar claiming experience expected to occur over the following 12 months. Claims+ adjusts the manual’s age, gender, and geography factors to include behavioral variation on the same scale.
Example: 0.65
Interpretation: 0.65 * base rate to get the expected premium assignment.
Profit +
Verikai margin prediction factor.
Profit+ predicts the total first-dollar margin, providing insight into the assigned premium minus the first-dollar claiming experience expected to occur over the following 12 months. Normalized on the experience of over 10,000,000 members with 100% loss ratio at 70% RTM, Profit+ is baselined at 0.0 as an absolute, not relative, factor. Values less than 0 signal that the total first-dollar claims will come in lower than the assigned premium.
Example: -1.04
Interpretation: Total margin predicted to be 1.04x the base premium rate.
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