In an experience report, which elements are included in fully insured plans?

In an experience report, which elements are included in fully insured plans?

• A. Stop loss and admin fee.
• B. Pooling point and premium.
• C. Stop loss and pooling point.
• D. Admin fee only.

Answer: (B)

In a fully insured plan, the insurer bears the risk and charges a fixed premium to cover expected claims plus administrative costs. The experience report for this setup focuses on two components: the premium, which is the fixed payment to fund the plan, and the pooling point, which reflects how claims are aggregated within the insurer’s risk pool to set rates. Stop loss is a reinsurance tool used with self-funded or partially funded plans, and admin fees are typically embedded in the premium rather than separate items in this context. So the elements that belong in the experience report for fully insured plans are pooling point and premium.

In a fully insured plan, the insurer bears the risk and charges a fixed premium to cover expected claims plus administrative costs. The experience report for this setup focuses on two components: the premium, which is the fixed payment to fund the plan, and the pooling point, which reflects how claims are aggregated within the insurer’s risk pool to set rates. Stop loss is a reinsurance tool used with self-funded or partially funded plans, and admin fees are typically embedded in the premium rather than separate items in this context. So the elements that belong in the experience report for fully insured plans are pooling point and premium.