Building a Fully Insured Equivalent Rate
Plansight lets you control how a self-funded option is illustrated by setting a fully insured equivalent rate.
From the modeler, go to the Rates tab and choose to model rates. You can apply a rate to a single option or model options independently, which is how most multi-option scenarios are handled.
Enter the fully insured equivalent rate you want to illustrate. Plansight will multiply that rate by enrollment and account for all fixed costs, including medical administration, pharmacy administration, stop-loss premiums, and any additional fixed items you’ve included.
Once those fixed costs are applied, Plansight backs into the remaining amount and treats it as claims cost. Those claims are then reflected consistently throughout the system, including the Benefit Builder, the total medical cost summary, and the final presentation.
If you don’t enter a fully insured equivalent rate, Plansight will automatically calculate projected claims using the rating factors and corridor. If you do enter your own rate, Plansight uses it as the source of truth and updates the claims and presentation accordingly.
The video in this article walks through how to set the rate and see how it flows through the illustration.
Questions this article answers • How do I set a fully insured equivalent rate for a self-funded plan? • Where is the Rates tab in the Modeler for self-funded? • What happens if I don't enter a rate for a self-funded plan? • How does Plansight calculate projected claims from rating factors? • How do I model rates independently for each plan option? • What is the corridor and how does it affect self-funded claims? • How does the budget rate multiply by enrollment to calculate costs? • How do fixed costs get subtracted to determine claims cost? • Does the fully insured equivalent rate update the Benefit Builder automatically? • How do I manage a dual option self-funded plan? • Can I enter my own rate or let Plansight calculate one? • Where do self-funded budget rates show up in the presentation? • How does Plansight back into claims cost from a fully insured equivalent rate? • What fixed costs does Plansight account for when calculating claims?