Benefit Content Analysis

The work product is the comparison of the economic value of Benefit A with the economic value of Benefit B. Experience studies of the historical claims experience of known benefits (hospital, outpatient surgery, Rx, e.g.) provides the actuarial basis for comparing dissimilar benefits. The work product expresses the value of A as 100 and the value of B as 88, e.g. So called penetration, or usage, factors are used where both in and out of network benefits are found. The work product may be modified by actual claims between A and B but most commonly is not so used.

The usual data provided for such Analyses is the Schedule of Benefits for A and B. If claims experience is relevant and significant it s availability should be useful and may be used.