Process Group

Financial Operations Management

Objective

Optimize premiums to reflect realistic economic conditions while minimizing medical loss ratio.

Input

• Fee schedule

• Actuarial projections (i.e. health spending projections

• Claims history

• Benefit plan

Output

• Premium rate schedule (premiums for each benefit plan

• Update premium collection amount

Measurable Outcomes

• Premium rates schedule for each benefits class

• Sum of premiums sufficient to meet the cost for medical claims and reserve funds for the year

Sources

• Joint Learning Network, 2012

• File: NHIIS_Phase_1_Public_Report_JLN_IT_Workshop_FINAL_Jan182012_A4.pdf