Public Sector

Excess-of-Loss Rating Model

The Reden & Anders Excess-of-Loss Rating Models develop excess-of-loss premium rates for various populations with two tools; the Hospital Model calculates rates for hospital-only and global coverages and the Physician Model calculates rates for professional coverages.

The Excess-of-Loss Rating Models free you from endless data overload by transforming data into timely information—information that is needed for business-critical decisions.

Support for key underwriting questions

Get answers to questions such as: What are the rate relationships between different packages of covered benefits? What is the impact of changing the specific deductible or increasing the average daily maximum? What is the incremental cost of adding outpatient and physician coverage to inpatient hospital coverage? What is the impact of excluding transplant coverage? How does our experience compare to a “manual” rate? and How do different approaches to claims accumulation affect the expected excess cost?

Regular updates to claims distributions and rating factors

  • Factors for rating physician contracts at any multiple of the current year’s Medicare RBRVS schedule are updated annually, including GPCI adjustment factors.
  • A table of average billed charges per day for virtually all U.S. hospitals is updated annually. The table includes average charge data by major admit type (neonates transplants, all other) for commercial and Medicare populations.
  • Claims distributions and all rating factors are updated every two years. The update also typically enhances the functionality of the Models.

Benchmark managed care data

The Reden & Anders Excess-of-Loss models offer you the same data used by actuarial consultants to assist in the analysis and development of managed care contacts. The utilization assumptions in the models are supported by the Reden & Anders Managed Care Utilization Rate Estimates (MCURE™) database.