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Risk Assessment

Risk Assessment

New Business Underwriting

Our first step in new business underwriting begins by using our risk assessment processes to evaluate each worksite client prospect based on their own unique merits. Next, we use our proprietary tools and processes to assign each prospect a relative risk score and corresponding premium level for each plan offering. At the end of the process we re-test each new worksite client joining the master health plan; making certain our clients get the enrollment results they expected.

Through our proprietary GrowthMetrics© program, plan sponsors can oversee the growth and change in their plans, in near real-time – rather than waiting for renewal proposals for feedback. In this program, Prospective Risk Management evaluates the impact of each addition or termination to the plan using expected per employee per month (PEPM) premium and claims, overall risk factor, and anticipated medical cost ratio impact. This prompt feedback allows you to plan and manage the renewal process – not react to it.

Our underwriting and renewal efforts and are not a once-a-year event – but rather an ongoing 12 month process continuously laying the groundwork for a managed outcome. Jointly we develop a plan, watch it unfold, and arrive at the result that you seek – all in the name of client satisfaction and retention.

Renewal Underwriting

Are all your individual client group premiums adequate to cover projected costs, without being excessive? Or are you at risk of poor client retention? Our unique renewal underwriting process gives you cutting-edge control over your plan – using predictive modeling to support proactive plan management – one group at a time and for all groups together. Our methodologies differ greatly from the traditional retrospective claim-only based analysis – we focus on where the plan is going, not where it has been.

Prospective Risk Management uses industry-leading predictive modeling systems to evaluate the risk of each existing employer group at renewal. We gather a combination of recent medical and pharmacy claims history, demographics, current pricing levels and plan designs, and the most current medical cost data warehouse applications for the evaluation. Once this look-forward process is complete, each client worksite is assigned a risk score used to set premium levels for the coming year.

Once the initial prospective risk scoring is complete, we immediately test the entire plan. Each worksite client is evaluated for goodness-of-fit with the plan’s rating structure and individual client assignment to specific premium levels. Using our unique RenewalMetrics© tools, you know how each worksite client’s risk level compares to its current premium.

Our process allows you to fairly and objectively balance the best interests of your existing clients and provides a strong platform for your new business to succeed