Process Group
Financial Operations Management
Objective
Optimize premiums to reflect realistic economic conditions while minimizing medical loss ratio.
Input
Actuarial projections (i.e. health spending projections
Claims history
Output
Premium rate schedule (premiums for each benefit plan
Update premium collection amount
Measurable Outcomes
Sum of premiums sufficient to meet the cost for medical claims and reserve funds for the year
Source: Joint Learning Network Report 2012
File: Determining Common Requirements for National Health Insurance Information Systems (JLN, 2012)