Was Your Rate Increase Earned or Imposed?

A BUCA renewal on a +200 life, fully-insured case warns the information contained in the re-rate calculation is CONFIDENTIAL and proprietary. Therefore we cannot confirm or deny its Blue Cross.

Here are some highlights of interest:

1. Out-of-network reimbursement is based on 105% Medicare for professional care, and 140% Medicare for facility care. This is a change over the prior year – “This change helps in controlling rising health care costs. Our Medicare based coverage generally is leaner than our previous coverage for out-of-network services.”

2. “Your claim experience and rates are lower due to negotiated savings. The claim experience shown also includes access fees which are a percentage of savings achieved.”  

3. State taxes, assessements and/or other charges, reinsurance contribution, health insurance providers fee, and “other adjustment” = 7.5% of premium. 

4. Target loss ratio of 80% is divided into expected claims 

5. Trend is 9.85% health, 10.50 Rx 

6. Additional fees of $5 pmpm for “the coverage of Hepatitis-C treatments, including Sovaldi.” 


This case is getting a +20% renewal increase of which 7.5% is politically driven through mandated taxes. The rest of the increase is partially due to the MLR mandate (also politically driven), and undisclosed fixed costs added to the claim side of the ledger. THIS GROUP HAS NOT EARNED A PREMIUM INCREASE, IT WAS IMPOSED UPON THEM.