FN 18 - ASO Plans - section d

[LuciP-NHP]

Is there any guidance around item 18d - Total Claim Payment Volume? I want to be able to confirm how this is derived since this is new to our business. Thank you.

[Glenn]

Unfortunately the NAIC instructions are very general with respect to Note 18A section d - claim payment volume.

Here is the excerpt from the NAIC instructions for Note 18A :

18. Gain or Loss to the Reporting Entity from Uninsured Plans and the Uninsured Portion of Partially Insured Plans

Instruction:

Provide information with regard to the profitability to the reporting entity of uninsured accident and health plans and the uninsured portions of partially insured plans for which the reporting entity serves as an Administrative Services Only (ASO) or an Administrative Services Contract (ASC) plan administrator.

A. ASO Plans

For ASO plans, provide the following information with regard to the profitability to the reporting entity of all ASO plans and the uninsured portions of partially insured plans for which the reporting entity serves as an administrator.

For the total and each category separately provide:

Net reimbursement for administrative expenses (including administrative fees) in excess of actual expenses

Total net other income or expense (including interest paid to or received from plans)

Total net gain or loss from operations

The claim payment volume

As you can see it is not helpful. Now I teach at many Health clients and review many of their notes. I see disclosed in Note 18A section d the total dollar $$$ amount of claims paid by the reporting entity in administration of the claims for the self insured plans ( the Plan sponsor).
The claim payment volume would be the claims paid ( expressed in dollars $$$) for the ASO business( uninsured business) for the Plan sponsors ( self-insured).

Hope this helps.

Regards,
Glenn S Sackett