Actuarial Consulting Services

The vendor is required to provide actuarial consulting services for health benefit plan state reinsurance program support and other activities.
- Conduct a risk adjustment analysis, regarding the individual market, by analyzing the collected data, including the following:
• The data will be run through the latest federal risk adjustment model to replicate the risk transfers for this population under the expected regulations and guidance.
• Risk transfers will be applied at a member-level such that each member will have an “adjusted claim amount” and a claim premium loss ratio.
- The member-level data adjusted to the following year, the contactor shall summarize the data, both with and without the impact of reinsurance.
- The contractor should make recommendations as to whether an adjustment (a “dampening factor”), with a specified factor, to reinsurance payments is warranted.
- Actuarial analysis and actuarial certifications to support state estimates that the proposed waiver will comply with the comprehensive coverage requirement, the affordability requirement, and the scope of coverage requirement.
- Provide an updated projected cost for the young adult subsidy program daily during open enrollment and weekly outside of open enrollment.
- Provide and iterate upon actuarial value calculator screenshots and value plan benefit design matrices during the annual value plan modification and/or design process.
- Contract Period/Term: 1 year
- Pre-Proposal Conference Date: March 19, 2025
- Questions/Inquires Deadline: March 28, 2025