25 For each plan, explain in detail and provide justification whether the premium rate for the plan varies from the market wide rate for the following factors: The actuarial value (AV) and cost-sharing design of the plan. The plan’s provider network and delivery system characteristics, and utilization management practices. Plan benefits in addition to the essential health benefits. Administrative costs, excluding Exchange user fees. You must also provide a table that summarizes the above factors for each plan, and show the projected membership by plan and the weighted average factors for the risk pool. 26 For each plan that is a renewal plan in 2019, provide a table that summarizes the items listed above (#25) in your 2019 filing and in the 2018 filing. For a change to any factor, explain the reason for the change and documentation of the proposed 2019 value. In particular, for a change to each network factor, explain in detail how the previous factor was established noting what network is represented by a factor of 1.000 and whether the network factors reflect efficiency, fee schedule, fee for service or bundled payments, whether the factors are derived using projected 2019 data or current/historical data. Please state the adjustment made to URRT Section II to show the impact of the networks compared to the experience period. State whether the company’s provider compensation includes bonuses in addition to other payments. If it does, explain how the anticipated payment was determined and where in URRT it has been included.
25 For each plan, explain in detail and provide justification whether the premium rate for the plan varies from the market wide rate for the following factors: The actuarial value (AV) and cost-sharing design of the plan. The plan’s provider network and delivery system characteristics, and utilization management practices. Plan benefits in addition to the essential health benefits. Administrative costs, excluding Exchange user fees. You must also provide a table that summarizes the above factors for each plan, and show the projected membership by plan and the weighted average factors for the risk pool. 26 For each plan that is a renewal plan in 2019, provide a table that summarizes the items listed above (#25) in your 2019 filing and in the 2018 filing. For a change to any factor, explain the reason for the change and documentation of the proposed 2019 value. In particular, for a change to each network factor, explain in detail how the previous factor was established noting what network is represented by a factor of 1.000 and whether the network factors reflect efficiency, fee schedule, fee for service or bundled payments, whether the factors are derived using projected 2019 data or current/historical data. Please state the adjustment made to URRT Section II to show the impact of the networks compared to the experience period. State whether the company’s provider compensation includes bonuses in addition to other payments. If it does, explain how the anticipated payment was determined and where in URRT it has been included.
cl-rates-19-sg-non-grandfathered-health-plan.docx