Group Benefits Funding and Pricing

Lesson 1: Introduction to Group Benefits Funding

1. Plan Funding Defined
2. Funding Arrangements
3. Primary Funding Arrangements
4. Financial Risk
5. Factors Affecting Funding Arrangement Options
6. Assessing Funding Arrangement Options
7. Significance of Pooling in the Plan Funding Decision
8. Types of Pooling
9. Significance of Group Size for Plan Funding Decisions
10. Significance of Predictability and Cost of Claims for Plan Funding Decisions
11. Insured Nonrefund Arrangement Defined
12. Basis of Premium Rate Renewal
13. Fully Pooled Rating on Plan Renewal
14. Types of Benefits Appropriate for Fully Pooled Rating
15. Prospectively Rated Renewal Rating
16. Types of Benefits Appropriate for Prospectively Rated Renewal Rating

Total pages in this lesson: 15 pages

Lesson 2: Group Benefits Funding: Insured Refund

1. Insured Refund Arrangement Defined
2. Financial Risk
3. Insured Refund Claims Experience
4. Basis of Premium Rate Renewal
5. Types of Benefits Appropriate for Insured Refund Arrangements
6. Types of Plans Appropriate for Insured Refund Arrangements

Total pages in this lesson: 6 pages

Lesson 3: Group Benefits Funding: Self-Insured Arrangements

1. Self-Insured Arrangement Defined
2. Types of Benefits Appropriate for Self-Insurance
3. Self-Insured With Pooling Arrangement
4. Large Amount or Individual High-Limit Pooling
5. Pooling From the First Dollar
6. Aggregate Stop-Loss Pooling
7. Durational Pooling
8. Administrative Services Only (ASO) Arrangement Defined
9. Payment Options in an ASO Arrangement
10. Claims Processing Procedures in an ASO Arrangement
11. ASO Annual Financial Accounting
12. Financial Liability in an ASO Arrangement
13. Basis of Premium Rate Renewal

Total pages in this lesson: 15 pages

Lesson 4: Group Benefits Pricing Considerations

1. The Pricing Equation
2. Factors to Consider in the Initial Pricing of Group Insurance
3. Manual Rating Defined
4. Calculating Manual Premium Rates
5. Experience Rating Defined
6. Difference Between Manual Rating and Experience Rating
7. Renewal Underwriting Defined
8. Claims Under a Group Insurance Policy
9. Types of Claims Covered Under a Group Life Insurance Policy
10. Claim Frequency
11. Cost of an Incurred Claim
12. Incurred but not Reported (IBNR) Reserve
13. Expenses Incurred Servicing the Plan Sponsor
14. General Administration Expenses
15. Claims Administration Expenses
16. Risk Charges
17. Profit Margins
18. Taxes

Total pages in this lesson: 20 pages

Lesson 5: Other Factors Affecting Group Benefits Pricing

1. Factors That Affect Pricing of Group Insurance
2. Cost Trend Factors for Health Care Benefits
3. Cost Trend Factors for Dental Benefits
4. Volumes
5. Maximums
6. Nonevidence Maximum
7. Overall Maximum
8. Factors That Determine the Level of an Overall Maximum
9. Renewal Underwriting Process
10. Changes in Group Demographics
11. Claims Experience During the Year
12. Credibility Factor of the Group’s Experience
13. External Factors

Total pages in this lesson: 13 pages