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1)
Provide the index rate
in c) (below) for the basic health
benefit plan required by 33-22-1827,
MCA, as detailed in your answer to b)
and issued to a small employer group
with the set of case characteristics
described in a):
a)
Assume the group has 5
employees, all insured under the small
employer group plan and none with
dependents, and that each person is
age 40 and lives and works in
Helena
,
Montana
, and they all work for a general
merchandise store.
All 5 employees are
non-smokers.
b)
Describe this group’s
plan in terms of the cost-sharing
arrangements described in
33-22-1827(2), MCA, using cost-sharing
arrangements most commonly chosen in
the actual current small employer
insurance market.
c)
The index rate for this
group insured under this health plan
is __________ per employee per month.
2)
Identify and describe
each small employer plan available in
terms of the types of benefits it
provides (or does not provide)
compared to the benefits required for
the basic health benefit plan required
in 33-22-1827(2), MCA.
If several sets of cost-sharing
arrangements are available, describe
the set available for each plan with
each possible combination of
cost-sharing arrangements.
Do this for the basic health
benefit plan described in 1) b) as
well.
3)
For each plan identified
in 2), provide the index rate per
employee per month.
For this purpose, assume that
each plan is issued to a group with
exactly the same case characteristics
described in 1) a).
4)
For each possible case
characteristic that could be reflected
in a group, provide the index rate per
employee per month for the plan
described in 1) b) for a group with
one different case characteristic from
the group described in 1) a), as
described in each section below:
a)
For each age (or age
bracket) for which the premiums are
different from the age 40 employee
premium, provide the index rate per
employee per month for each small
employer group where all 5 employees
are the same age, other than 40, with
all other case characteristics the
same as those described in 1) a).
b)
For each group size for
which the premiums are different from
the group size 5 employee premium,
provide the index rate per employee
per month for each small employer
group of each group size other than 5
employees, with all the other case
characteristics the same as those
described in 1) a).
c)
For each geographic area
for which the premiums are different
from the Helena area employee premium,
provide the index rate per employee
per month for each small employer
group in each of these geographic
areas, with all other case
characteristics the same as those
described in 1) a).
d)
For each industry
classification for which the premiums
are different from the general
merchandise store employee group
premium, provide the index rate per
employee per month for each small
employer group in an industry
classification other than the general
merchandise store classification.
(It is not necessary to provide
an index rate for each possible
industry; choose one industry for each
possible load or discount to the
general merchandise store industry
factor for this purpose.)
Assume all
other case characteristics are the
same as those described in 1) a).
e)
For each spouse, child,
and/or composite dependent, provide
the factor that would be applied to
the index rate provided in 1) c) and
the factor that would be applied to
each index rate in 4) a) to obtain the
index rate by age (or age bracket) for
each dependent classification used by
the small employer carrier.
Assume that all 5 employees
have the same employee/spouse/children
or employee/composite dependent
combination.
f)
For all other case
characteristics used by the small
employer carrier not described above,
describe these case characteristics,
and provide the index rate for the
plan described in 1) b) for each of
those case characteristics separately,
assuming that all other case
characteristics are the same as those
described in 1) a).
5)
Provide the formula used
to determine the rate increase for all
small employer groups during the year
for which this actuarial certification
is being filed, consistent with the
method described in 33-22-1809(1)(c).
a)
Describe how the
percentage change in the new business
rate referred to in 33-22-1809(2)(c)(i),
MCA, is determined.
b)
Describe how the portion
of the increase described in
33-22-1809(2)(c)(ii), MCA, is
determined for claims experience, for
health status, and for duration of
coverage.
6)
Finally, provide the
certification as described in the
first sentence of 33-22-1809(5)(b).
Be sure to note any places
where a group’s rates were not in
compliance with any part of
33-22-1809, MCA.
Please note that the actuarial
certification must be signed by
a Member of the
American
Academy
of Actuaries who is qualified to sign
this certification. |
