x of Premiums, Enrollment and Utilization

[LystraD-GLIC]

Hello, can you provide some guidance on the Health page 7, Ex of Premiums, Enrollment and Utilization, lines 2, 3, 4 & 6? Should Line 4 be a sum of January through September? How is this different from Line 6? Current Year member months?

What is the difference between Total Members and Current Year Member Months?

Thanks

[LystraD-GLIC]

Also, does line 6 reconcile to page 4, line 1?

[Glenn]

Hello,
First you refer to page 7 but I believe you meant page 30 as this is the Exhibit of Premiums, Enrollment and Utilization page you are inquiring about.

Please see the NAIC instructions for each line on page 30 below:

I believe the instructions are helpful here in this case

Line 1 Total Members at End of Prior Year

A member is a person who has been enrolled as a subscriber, or an eligible dependent of a subscriber, and for whom the reporting entity has accepted the responsibility for the provision of basic health services as provided by contract.

Line 2 Total Members at End of First Quarter

Show total members (cumulative) at the end of the quarter.

Line 3 Total Members at End of Second Quarter
Show total members (cumulative) at the end of the quarter.

Line 4 Total Members at End of Third Quarter

Show total members (cumulative) at the end of the quarter.

Line 5 Total Members at End of Current Year

Show total members at the end of the year.

Line 6 Current Year Member Months

A member month is equivalent to one member for whom the reporting entity has recognized premium revenue for one month. Where the revenue is recognized for only part of a month (or other relevant time period) for a given individual, a pro-rated partial member month may be counted. Accumulate member months for the period.


Also, here is an excerpt from our Health handbook which should help with these line items

Member Information Section

Lines 1 through 5 Total members The Annual Statement Instructions provide the same definition of member as for Exhibit 1 ? Enrollment by Product Type for Health Business Only:
A member is a person who has been enrolled as a subscriber, or an eligible dependent of a subscriber, and for whom the reporting entity has accepted the responsibility for the provision of basic health services as provided by contract.
It should be clear from this definition that the term ?member? includes not only the primary insured person but also all covered dependents. Tabulation of member counts on quarterly and annual statement dates ordinarily is performed using the inforce policy or member system to obtain an exact count. However, there may be situations where an approximation must be employed for example, when the plan premium structure includes a family rate that does not depend on the number of family members. If the company does not obtain the identities of all covered members and therefore does not have the ability to tabulate exactly the count of all covered family members, it may be acceptable to perform a statistical abstraction from sampling the covered population.
Line 6 Current year member months - The Annual Statement Instructions provide the same definition of member months as for Exhibit 1 Enrollment by Product Type for Health Business Only:
A member month is equivalent to one member for whom the company has recognized premium revenue for one month. Where the revenue is recognized for only part of a month (or other relevant period) for a given individual, a prorated partial member month may be counted. Accumulate member months for the period.
The Annual Statement Instructions for Exhibit 1 and the State Page do not suggest a procedure for tabulating member months. However, the NAIC does suggest a procedure in the Annual Statement Instructions for the Accident and Health Policy Experience Exhibit:
The sum of total number of lives insured on a pre-specified day of each month of the reported year. Reasonable approximations are allowed when exact information is not administratively available to the reporting entity.
See Exhibit 1 of this Handbook for a discussion of Exhibit 1 and Medicare Supplement Insurance Experience Exhibit for a discussion of the Accident and Health Policy Experience Exhibit. Both sections include discussions of member information such as member counts and member months.


And, yes page 30 line 6 should cross check to page 4 line 1

Hope this helps
Glenn S Sackett