SOA GH DPGroup & Health — Design & Pricing

A 300-life group has experience claims PMPM of 450 (after pooling); manual is 400; credibility 0.6; pooling charge 30. The experience rate is:

A 1,200-employee employer is fully insured and asks whether to move to self-funding with stop-loss. Evaluate the options (fully insured, minimum premium, ASO with specific and aggregate stop-loss) on risk, cash flow, cost and regulation, and recommend.