Risk Adjustment for HMO Basic Plans
Beginning in 2022, CalPERS will risk adjust the premiums for the Health Maintenance Organization (HMO) Basic plans. This change is the result of a year-long analysis and subsequent policy change designed to stabilize the Basic plan portfolio.
By pricing plans based upon the value of their benefit design and network, rather than the concentration of healthy or unhealthy lives in them, plans will compete on cost and quality of care instead of relying on their ability to attract younger and healthier members.
CalPERS Preferred Provider Organization (PPO) Basic plans will be priced based on their benefit and network differentials. Medicare plans aren’t included in our risk adjustment process.
To review the complete article and charts, please visit the link HERE.
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