MEDICAL,USA: Establishing premium rates for an insurance company’s policies by using a formula. In life insurance, important factors considered are mortality rates, interest rates, and loading.
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The process of developing pricing structures for insurance.
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A manual containing rates for various coverage, information and instructions for field underwriting, insurer’s rules for the guidance of agents and similar other risk acceptance guidelines.
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A manual that contains the rates for coverages, and can contain other items such as guidelines to field underwriting, agent guidelines, and cash forfeiture values.

System used to bill for group health insurance based on type of contract or age/sex breaks.

System of comparing costs of life insurance policies by using the following formula: 1. Determine pure cost of protection (mortality expectation). 2. Calculate amount of dividends paid. 3. Subtract the pure cost of protection plus dividends from the gross premiums paid into the policy (savings element). 4. Rate of return equals the interest rate at which the savings element must be accumulated to equal the cash value of the policy at a future specific time period. Also called Linton yield method .

To ask for a set of insurance rates that are based on a specific list of benefits.

System in health insurance for establishing premiums so that an insurance company’s premium varies by not more than a fixed amount from other premiums for individuals in the same premium class within a certain geographical region.

Advance evaluation of a health care facility’s financial data by a government or private agency to determine the reasonableness of the hospital fees and assess a possible increase in the fees.

1. System used to contain health care costs in which the government sets payment fees for all insurance payers for categories of medical services. 2. In the Medicare program, to determine and establish the cost of medical professional services provided to a patient by using historical cost data reported by providers.

If a specific account’s actual experience at the close of an insurance contract period results in excess funds, these can be applied toward the account’s rate for the next year, which helps offset the rate increase.

1. Determining the value of risk of an individual or organization. 2. Establishing a year’s cost of a specific unit of insurance.
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Any procedure used to compute the premium rate which a particular insured or class of Insureds is charged for a given coverage.

Rate applied to risks of similar characteristics or a specific class of risk. For group life insurance the three rating classes for group premiums are (1) manually rated premiums, (2) experience-rated premiums, and (3) blended premiums. See also blended rates, experience rating, and manual rate .