A system that allows insurance companies to evaluate the risk of insuring an individual or group by looking at the applicant's health history.
The rating method used by most traditional indemnity insurers, which uses the group claims experience to establish premium rates.
Experience rating is a method of HMO rate calculations where the rate charged to a group for HMO coverage is based on the profit or loss experience of that particular group.
A special rate modification for insurance, in which a deviation from the manual rate is made because of the incurred past experience record of the individual risk involved.
A technique insurance companies use to determine the correct price of a policy premium.
A method of setting premium levels for an insured based upon the insured's loss history. Also known as retrospective rating.
The method used by insurers to adjust the premium of a group to reflect the actual claim experience of the group.
the practice of basing insurance premiums on a policyholder's past loss history.
In group health insurance, a review of the previous year's group claims experience (or loss) used to establish premiums for the next period.
A merit rating that bases calculation of the policy premium on previous loss experience. (See also, Merit Rating.)
A method for determining an employer's workers' compensation premiums that reflects a) a comparison of the employers recent loss experience with the amount the employer would have been expected to pay if it had been an average employer in the same industry with the same payroll and b) the credibility or confidence assigned to the employer's loss experience. In practice, insurers assign no credibility to employers with average class premiums below a certain amount (e.g., $5,000/yr).
A method of determining premiums based on the cost and use of benefits for specific groups. All of our groups having 51 or more subscribers are experience-rated.
The tax rate calculated on the activity in the employer's account including taxes paid and benefits charged.
A system of pricing insurance in which the future premium reflects the actual past loss experience of the insured.
A practice in which premium rates for health insurance are based on the past cost experiences of the enrolled individual or group.
Experience rating is a method used to determine premium rates, based on the claims activity over a period of time for a particular group. It's usually expressed as a percent or ratio.
A method of rating, which takes into consideration the loss history of a particular risk and applies a credit or debit to future rates accordingly.
A method of calculating premiums based on prior claims experience and exposures such as payroll.
A rating method under which a Managed Care Organization analyzes a group's recorded health care costs by type and calculates the group's premium partly or completely according to the group's experience.
Creating premium rates for a group by taking into consideration the previous claims experience of the group.
A method of adjusting the premium for a risk based on past loss experience for that risk compared to loss experience for an average risk.
A form of individual risk rating which takes into consideration the loss experience of the particular risk as a credit or a debit to the manual rate for the insured's classification. As the size and number of exposure units increase (e.g., a multiple location risk), more credibility is given to the insured's experience.
Determination of the premium rate for an individual risk, made partially or wholly on the basis of that risk's own past claim experience.
A system of measuring an employer's workers' compensation loss history compared to the “expected losses” of the “average” employer in the same industry. The experience period used in a risk's modification generally consists of three completed years of experience ending one year prior to the effective date of the modification.
In the context of unemployment compensation, it is the employers past record of unemployment claims activity. This record is used to determine the employers unemployment tax rate (i.e., a high unemployment rate results in a higher tax rate).
A process administered by the WCB usually based on a three year time period, premiums paid and compensation rates.
Type of merit rating that determines premium based on previous loss experience.
A method of establishing payer premiums or capitation rates based on historical utilization data and characteristics of potential subscribers, such as age, gender, and health status, that are believed to affect utilization and costs.
The process of setting rates partially or in whole on evaluating previous claims experience for a specific group or pool of groups. The rating system by which the Plan determines the capitation rate or premium rate is determined by the experience of the individual group enrolled, based on actual or anticipated health care use by the specific group of insureds. Each group will have a different rate based on utilization. This system tends to penalize small groups with high utilization. A method of adjusting health plan premiums based on the historical utilization data and distinguishing characteristics of a specific subscriber group, such as determining the premium based on a group's claims experience, age, sex or health status. Experience rating is not allowed for federally qualified HMOs.
A system of determining the amount of the premium to be paid under a health care plan. The premium is based on the particular characteristics of the group involved, for example, the employees of a particular employer. Thus factors such as sex, age, and prior usages of health care services of the group may be considered in fixing premiums. (Related: Community Rating, Medical Indemnity) Fee-for-Service (FFS) The traditional method by which health care professionals and institutions have been compensated. When a medical item or service is received, a fixed amount is billed and paid for in cash or by health care insurance.
The process of using a group's own premium and claims experience to calculate premium rates. If the claims experience for the previous year was favorable, the insurer considers reducing the premium rates for the coming year. If the experience was unfavorable, the insurer attempts to discover the reason and may propose higher premiums for the next year.
An insurance pricing system in which the insured's past experience determines the premium for the current protection.
The process of determining the premium rate for a group risk, wholly or partially on the basis of that group's experience.
A method of establishing health insurance premiums in which a premium for a specified population is based on the average cost of actual or anticipated health care used by members of that population. Variables such as age, gender, and health status affect that rating.
A plan available for fidelity bonds whereby surcharges or discounts are applied to premiums developed by those risks based on the actual past experience of such risks.
Process of determining the premium rate for a group based wholly or partially on that group's risk experience.
A method of determining a group’s premium rates based wholly or partly on the group’s own claims experience.
A method of calculating group insurance premium rates by which the insurer considers the particular group's prior claims and expense experience. See also manual rating and pooling.
Process of determining the premium rate for a group risk based wholly or partially on that risk's experience.
In the context of unemployment compensation, it is the employer's past record of unemployment claims activity. This past record is used to as part of the determination of the employer's unemployment tax rate (i.e., the higher the turnover rate, the higher the tax rate).
A method of determining the premium for a health insurance policy based on the average cost of actual or anticipated utilization of care by various groups. ederally Qualified HMOs HMOs that meet certain federally stipulated provisions aimed at protecting consumers, e.g., providing a broad range of basic health services, assuring financial solvency and monitoring the quality of care.
Rating of an insurance based on the record of a particular insured.
System for determining risk and setting premiums by considering the cost of medical claims incurred by a group.
a plan, available in certain lines of casualty insurance, which is applicable to risks that meet qualifying tests. This plan provides that manual rates (average rates that reflect the experience of large groups of similar risks) shall be increased or decreased in accordance with the actual past experience of such risks.
A method of rating that uses past experience to establish current rates.