Code of Federal Regulations (Last Updated: July 5, 2024) |
Title 48 - Federal Acquisition Regulations System |
Chapter 16 - Office of Personnel Management Federal Employees Health Benefits Acquisition Regulation |
SubChapter A - General |
Part 1602 - Definitions of Words and Terms |
Subpart 1602.1 - Definitions of FEHBP Terms |
§ 1602.170-7 - Experience-rate.
Latest version.
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1602.170-7 Experience-rate.
Experience-rate means a rate for a given group that is the result of that group's actual paid claims, administrative expenses (including capitated administrative expenses), retentions, and estimated claims incurred but not reported, adjusted for benefit modifications, utilization trends, and economic trends. Actual paid claims include any actual or negotiated benefits payments made to providers of services for the provision of healthcare such as capitation not adjusted for specific groups, including mental health benefits capitation rates, per diems, and DRG payments.
[70 FR 31378, June 1, 2005]