Adjusted community rate means the rating method used to
Adjusted community rate means the rating method used to establish the premium for health plans adjusted to reflect actuarially demonstrated differences in utilization or cost attributable to geographic region, age, family size, and use of wellness activities.
Adjusted community rate means a community rate which has been ad- justed for expected use of medical re- sources of the FEHBP group. An ad- justed community rate is a prospective rate and cannot be retroactively re- vised to reflect actual experience, utili- zation, or costs of the FEHBP group, except as described in § 1615.402(c)(4).[55 FR 27414, July 2, 1990, as amended at 62FR 47573, Sept. 10, 1997; 76 FR 38284, June 29,2011] 1602.170–3 Comprehensive medical plan.Comprehensive Medical Plan means a plan as defined under 5 U.S.C. 8903(4).1602.170–4 Contractor.Contractor means carrier.1602.170–5 Cost or pricing data.(a) Experience-rated carriers. Cost or pricing data for experience-rated car- riers includes:
Examples of Adjusted community rate in a sentence
Section 1602.170–2(b) is revised to read as follows:§ 1602.170–2 Community rate.* * * * *(b) Adjusted community rate means a community rate which has been adjusted for expected use of medical resources of the FEHBP group.
Adjusted community rate (ACR) is the equivalent of the premium that a risk HMO or CMP would charge Medicareenrollees independently of Medicarepayments if the HMO or CMP used the same rates it charges non-Medicareenrollees for a benefit package limited to covered Medicare services.
More Definitions of Adjusted community rate
Adjusted community rate means a community rate which has been adjusted for expected use of medical resources of the FEHBP group. An adjusted community rate is a prospective rate and cannot be retroactively revised to reflect actual experience, utilization, or costs of the FEHBP group, except as described in § 1615.402(c)(4). 1602.170-3 Comprehensive medical plan. Comprehensive Medical Plan means a plan as defined under 5 U.S.C. 8903(4). 1602.170-4 Contractor. Contractor means carrier. 1602.170-5 Cost or pricing data. (a) Experience-rated carriers. Cost or pricing data for experience-rated carriers includes:
Adjusted community rate means acommunity rate which has been ad- justed for expected use of medical re- sources of the FEHBP group. An ad- justed community rate is a prospective rate and cannot be retroactively re- vised to reflect actual experience, utili- zation, or costs of the FEHBP group.[55 FR 27414, July 2, 1990, as amended at 62FR 47573, Sept. 10, 1997] 1602.170–3 Comprehensive medical plan.Comprehensive Medical Plan means a plan as defined under 5 U.S.C. 8903(4).1602.170–4 Contractor.Contractor means carrier.1602.170–5 Cost or pricing data.(a) Experience rated carriers. Cost or pricing data for experience rated car- riers includes information such as claims data; actual or negotiated bene- fits payments made to providers of medical services for the provision of health care such as capitation not ad- justed for specific groups, per diems, and Diagnostic Related Group (DRG) payments; cost data; utilization data; and administrative expenses and reten- tions.(b) Community rated carriers. Cost orpricing data for community rated car- riers is the specialized rating data used by carriers in computing a rate that is appropriate for the Federal group and the similarly sized subscriber groups (SSSGs). Such data include, but are not limited to, capitation rates; pre- scription drug, hospital, and office visit benefits utilization data; trend data; actuarial data; rating methodologies for other groups; standardized presen- tation of the carrier’s rating method (age, sex, etc.) showing that the factor predicts utilization; tiered rates infor- mation; ‘‘step-up’’ factors information; demographics such as family size; spe- cial benefit loading capitations; and adjustment factors for capitation.[62 FR 47574, Sept. 10, 1997] 1602.170–6 Director.Director means the Director of the Of- fice of Personnel Management.[52 FR 16038, May 1, 1987. Redesignated at 62FR 47574, Sept. 10, 1997] 1602.170–7 Experience rate.Experience rate means a rate for a given group that is the result of that group’s actual paid claims, administra- tive expenses, retentions, and esti- mated claims incurred but not re- ported, adjusted for benefit modifica- tions, utilization trends, and economic trends. Actual paid claims include any actual or negotiated benefits payments made to providers of medical services for the provision of health care such as capitation not adjusted for specific groups, per diems, and Diagnostic Re- lated Group (DRG) payments.[54 FR 27414, July 2, 1990. Redesignated at 62FR 47574, Sept. 10, 19...