Experience-Rate Projection Calculator

Fully Insured Health Plan Renewal Analysis

Base / Derived Inputs
Base Experience Period (BEP)
Future Contract Period
Trend Method
%
$
$
%
%
$
$
$
$
Member Information
Cumulative across BEP
Adjustments
Pooling
%
$
Claims above pooling point
Rating Factors
%
%
Fixed costs, commissions
$
$
+/- risk load
How to Use This Calculator
1. Set Your Experience Period

Enter the Base Experience Period (BEP) dates for your incurred claims data, typically 12 months of historical claims.

2. Define the Contract Period

Enter the future 12-month period for which you're projecting premiums.

3. Choose Trend Method

Select blended (single factor) or separate Medical/Rx trending based on your carrier's approach.

4. Enter Claims Data

Input your incurred claims, pooling parameters, and member counts from the experience period.

5. Set Credibility & Adjustments

Enter your carrier's credibility percentage, retention load, rebates, and any demographic/benefit adjustments.

6. Compare Results

Review the side-by-side comparison of your specified credibility versus 100% experience rating.

Key Concepts
  • Credibility: Weight given to actual experience vs. manual rates. Higher member counts typically result in higher credibility.
  • Projection Factor: Compounds annual trend from BEP midpoint to contract midpoint to project future claims.
  • Pooling: Charge added for stop-loss protection, offset by claims above the pooling threshold.
  • Retention: Carrier's load for administration, commissions, profit, and other fixed costs.
  • PEPM: Per Employee Per Month - useful for comparing utilization measures on a per employee basis.
  • PMPM: Per Member Per Month - the standard unit for measuring healthcare costs.