Our Consulting Services For Health Insurers


Every health insurer in the industry could dramatically improve the techniques that they are currently using to underwrite and price "large groups" by "thinking outside the box" a lot more often, and by paying much more attention to the dynamics at play within each specific group that can substantially impact the group's loss ratio and/or their enrollment level in the upcoming plan year.      





















Our consulting services for health insurers focus on the following three areas:  

1. We can show you how to make SUBSTANTIAL IMPROVEMENTS to your experience rating formula and all of the factors that it relies on.  The vast majority of insurers are still using virtually the same experience rating approach that they were using 30-40 years ago.  Improvements are long overdue!  

2. We can also show you how to make VAST IMPROVEMENTS to the Community Rating by Class (CRC) pricing methodology that you're using to price large fully insured groups, and to partially price experience rated groups that are only partially credible.  Besides being extremely primitive, the CRC pricing methodology is 60+ years old and it routinely generates premium rates that are substantially off-target.  Health insurers be using 21st century pricing techniques to price their "large group" clients instead of using primitive pricing techniques that were invented in the 1950s!  

3. We can also show you how to implement innovative underwriting and pricing techniques that will enable your company to DEVELOP HIGHLY APPROPRIATE PREMIUM RATES for your large group clients by properly assessing the following:

  • Most large groups use one or more internal STRATEGIES to reduce and/or control their health plan costs.  Some of these strategies can result in a group's loss ratio increasing by as much as 8%, and their enrollment decreasing by as much as 25%.  We'll show you how to make appropriate premium adjustments for a wide variety of employer cost-reduction strategies to ensure that your profitability and enrollment targets are achieved.  Check out the agendas that describe our "on-site training programs" and our "case studies" page to learn more about the many types of cost-reduction strategies that employers are currently using that you need to properly react to in your pricing.

  • There are also many group-specific SITUATIONS that can have a substantial impact on a group's loss ratio and/or enrollment level.  We'll show you how to properly reflect the probable impact of a wide variety of these "situations" in a group's premium rates.  Check out the agendas that describe our "on-site training programs" for more info regarding the types of situations that need your attention.


If you have any questions about our consulting services, or you'd like a quote regarding a specific project, you can either email us at smsnow@smsnow.com or call us at (508) 393-1608.