Exhibit of Prem, Enroll & Util - Membership

[RobM-BCBSMI]

We have a question of how to count a member who has Medical coverage with a Dental and Vision optional rider. The Appendix - Definition of Lines of Business defines Dental-Only and Vision-Only as being coverage issued as either a stand alone product or as a rider to a medical policy (acts like a separate policy with separate premiums and deductibles).

In the example above, where the member has a medical policy with a dental and vision rider, the premiums and claims would be reported in the respective Medical, Dental-Only and Vision-Only columns of the PEU.

But how should the membership counting be reported? Would we allocate 1/3 of the member to each of the three lines of business; or based on the percentage of premiums; or use some other method? Or do we count it all as a medical? Same question applies with a member who has both Dental and Vision stand alone polices with no medical coverage.

[KenJames]

Our health resource Glenn Sackett is out of the office with a family emergency this week. He will get back to you next week.

[Glenn]

Since the instructions appear to be silent I could foresee allocating the membership 1/3 each across Comprehensive, Dental and Vision so that when you go to do any analytics by member you get a truer picture of things like Premiums and Costs PMM ( per member months)

Also here are the member instructions for the state page 30 that would support this logic:

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.



Look at line 6 instructions about pro-rated partial members.