Answered step by step
Verified Expert Solution
Question
1 Approved Answer
Using the template documented on the page labeled 43 of the case study, please complete 2 premium calculations as you act as the consultant for
Using the template documented on the page labeled 43 of the case study, please complete 2 premium calculations as you act as the consultant for this insurance company in its bid presentation.
For the first calculation use a $250 co pay for acute and mental health along with a $50 co pay for ER, $25 co pay for primary and $0 co-pay for SNF.
For the second calculation use a $0 co pay for acute, SNF, mental health and office visits for a specialist along with a $15 co pay for ER and $5 co pay for primary.
Copay Adjustment Factors Premium Development Worksheet Base PMPM Cost Adjusted PMPM Cost Utilization $ Facility Services Inpatient: Acute Skilled nursing Mental health Substance abuse Surgical procedures Emergency department Outpatient procedures Total facilities 0.41 1.0000 1.0000 0.41 3.43 1.0000 1.0000 3.43 Physician Services Primary care services Specialist services: Office visits Surgical services All other services Total physicians 9.00 23.67 0.9544 0.8659 1.0000 0.9100 8.59 18.65 Total medical PMPM amount II. Nonmedical Expenses Administrative Reserves Total nonmedical PMPM amount III. Total Expenses Total PMPM amount IV. Premium Rates Single Family Rate factor Premium rate
Step by Step Solution
There are 3 Steps involved in it
Step: 1
Get Instant Access to Expert-Tailored Solutions
See step-by-step solutions with expert insights and AI powered tools for academic success
Step: 2
Step: 3
Ace Your Homework with AI
Get the answers you need in no time with our AI-driven, step-by-step assistance
Get Started