Are SISC rate increases based on average expenditures of all members and/or region?

At the last meeting, it was stated that our current insurance is based on the cost as a whole group and our insurance has increased. Please explain if the new carrier insurance will do the same. Are rate increases of new carrier based on average expenditures of all members and/or region?

ANSWER

Per CECHCRs: In general, Self-Insured Schools of California (SISC) determines annual rate changes based upon a three-step process:

  1. First, the overall claims experience is determined for all districts within the pool on a statewide basis to determine the new rates for each plan option offered;

  2. Second, those statewide rates are adjusted (up or down) based upon regional variations in the cost of care from the local providers (hospitals, medical groups, etc.) delivering that care;

  3. Finally, those regionally adjusted rate changes (up or down) are then applied to the prior year premium rates for each individual district in that region. All districts in each region receive the same percentage rate changes for the same plan options[1].

[1] Percentage rate changes may vary for individual plan options within the various PPO, HMO and Kaiser offerings (i.e. traditional/select HMO, full network/select network PPO, etc.)"

 

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