Group rating

Priority Health uses different rating methodologies for different sized groups or health plans. Here are the details:

Small groups

Community rating

Priority Health uses a rating methodology that complies with Reform Group law.

• Priority Health adjusts community rates based on group-specific zip code, size, Standard Industry Classification (SIC) code, age and tier mix (single/double/family).
• Priority Health offers only 3-tier rates (single/double/family) with a standard rate slope.
• Contact your region's Priority Health small business representative or visit www.osha.gov for assistance with rating a small group employer.

Large groups

Fully funded - community rating

Priority Health uses industry factors, age, sex and family size in rating its large group products.

• We use the group's Standard Industry Classification (SIC) code and the group's census of employees.
• Plans can be designed to fit the specific needs and requirements of your client.

Fully funded - experience rated (PPO only)

For its PriorityPPO^SM product, Priority Health uses a common calculation method for pricing medical insurance products that has a history of successful prediction.

First, we calculate PriorityPPO manual rates using product-specific base rates:

• Base rates are developed annually based on historical claims data for the plan.
• Actuarially developed factors are used to adjust for the group's actual age/sex mixture, geographic area, average family size and industry.
• Reform groups will use age-only factor and group size factor. Additional minor factors are used in limited circumstances.
• These calculations result in the PriorityPPO manual rates.

Then, for larger groups with 75 or more insured lives:

• Our underwriters use at least 12 months' claim history along with demographics, trend factors and a plan change factor to estimate future claims and arrive at an experience-based premium requirement.
• Large claims are removed above a pooling point.
• These calculations result in experience-based premium rates.
• The experience-based premium rates are then blended with the manual rates to yield final PriorityPPO rates for the group.

Self-funded group rating

Priority Health uses community-based system in rating self-funded products

• We use prior claims experience, age, sex, family size and industry factors to arrive at competitive reinsurance coverage for your clients.
• Our extensive network of health care providers and portfolio of managed care services are important components of these products.
• We offer COBRA administration at a minimal charge through COBRA Compliance.

Contact your region's Priority Health large group representative for assistance with rating a large group employer.