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

Source: Joint Learning Network Report 2012

File: Determining Common Requirements for National Health Insurance Information Systems (JLN, 2012)