Anyone know of any standard tricks when evaluating experience from a self-funded group that uses RDS? Is there some kind of calculation or standard % amount that people assume when evaluating the claims costs to get a monthly premium cost on a per member per month basis?
Say for example I’m looking at company xyz and they have 541 members. The company offers a self-insured EGWP plan to the membership. They’re looking to off-load the risk to free up some capital reserves. The company policy holder hands you an experience file. Included is:
Coinsurance Amount Paid
Deductible Amount Paid
What you were able to confirm is that this group is using a RDS for their self-funded plan. They want to move away from that. Does anyone know how you would calculate a PBM’s rebates, and what would you consider to be a normal RDS % received in order to help whichever carrier you’re working with come up with the most compelling premium offering they can.
First Q: what is “RDS”? I might know it by a different name.
Second, a carrier should already have a system to come up with an estimate of Rx Rebate based on the past Rx claims of the group. Or, it will state, “every group gets $X/rx claim or $Y/rebate-eligible Rx claim.”
RDS = Retiree Drug Subsidy. I’m no expert, but I believe it is a subsidy that plans receive if they offer retiree coverage. It has mostly been replaced by EGWP because EGWP has more favorable tax incentives.