CMS-10637 Appendix A_AV Continuance Tables_508

Platinum Plans, Medical Only Continuance Table
OMB Control # 0938-1353
PRA DISCLOSURE:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1353 (Expires XX/XX/20XX). The time required to complete this information collection, annually, is estimated to average 4,639 hours per response for QHP issuers. These estimates include the time to maintain records of consumer case resolution and maintain a direct enrollment Web site. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850. ****CMS Disclosure**** Please do not send applications, claims, payments, medical records or any documents containing sensitive information to the PRA Reports Clearance Office. Please note that any correspondence not pertaining to the information collection burden approved under the associated OMB control number listed on this form will not be reviewed, forwarded, or retained. If you have questions or concerns regarding where to submit your documents, please contact Nik Berkobien at [email protected]
Expiration Date: XX/XX/20XX
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

ER

Avg. ER Freq

IP

Avg. IP Freq

Primary Care

Avg. Primary Care Freq

Specialist

Avg. Specialist Freq

Mental Health and Sub. Use Disorder

Mental Health and Sub. Use Disorder Freq.

Imaging

Avg. Imaging Freq

Speech Therapy

Avg. Speech Therapy Freq

Occ. + Physical Therapy

Occ. + Physical Therapy Freq

Preventive (Combined)

Avg. Prev. Freq (Combined)

Laboratory

Avg. Laboratory Freq

X-rays (Combined)

Avg. X-ray Freq (Combined)

X-rays (Specialist)

Avg. X-rays Freq (Specialist)

X-rays (Primary)

Avg. X-rays Freq (Primary)

X-rays (Unclass.)

Avg. X-rays Freq (Unclass.)

SNF

Avg. SNF Freq.

Unclassified

Avg. Unclassified Freq

Avg. IP Days

Avg. SNF Days

Mental Health - OP Facility

Avg. Mental Health - OP Facility Freq

Mental Health - OP Prof.

Avg. Mental Health - OP Prof. Freq

Imaging - OP Facility

Avg. Imaging - OP Facility Freq

Imaging - OP Prof.

Avg. Imaging - OP Prof. Freq

Speech Therapy - OP Facility

Avg. Speech Therapy - OP Facility Freq

Speech Therapy - OP Prof.

Avg. Speech Therapy - OP Prof. Freq

Occupational Therapy - OP Facility

Avg. Occ. Therapy - OP Facility Freq

Occupational Therapy - OP Prof.

Avg. Occ. Therapy - OP Prof. Freq

Laboratory - OP Facility

Avg. Lab - OP Facility Freq

Laboratory - OP Prof.

Avg. Lab - OP Prof. Freq

Unclassified - OP Facility

Avg. Unclass. - OP Facility Freq

OP Surgery

OP Surgery Freq

IP Max Days - 1

IP Max Days - 2

IP Max Days - 3

IP Max Days - 4

IP Max Days - 5

IP Max Days - 6

IP Max Days - 7

IP Max Days - 8

IP Max Days - 9

IP Max Days - 10

Primary Care >1 Visit

Primary Care >1 Visit Freq.

Primary Care >2 Visits

Primary Care >2 Visits Freq.

Primary Care >3 Visits

Primary Care >3 Visits Freq.

Primary Care >4 Visits

Primary Care >4 Visits Freq.

Primary Care >5 Visits

Primary Care >5 Visits Freq.

Primary Care >6 Visits

Primary Care >6 Visits Freq.

Primary Care >7 Visits

Primary Care >7 Visits Freq.

Primary Care >8 Visits

Primary Care >8 Visits Freq.

Primary Care >9 Visits

Primary Care >9 Visits Freq.

Primary Care >10 Visits

Primary Care >10 Visits Freq.

Gold Plans, Medical Only
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

ER

Avg. ER Freq

IP

Avg. IP Freq

Primary Care

Avg. Primary Care Freq

Specialist

Avg. Specialist Freq

Mental Health and Sub. Use Disorder

Mental Health and Sub. Use Disorder Freq.

Imaging

Avg. Imaging Freq

Speech Therapy

Avg. Speech Therapy Freq

Occ. + Physical Therapy

Occ. + Physical Therapy Freq

Preventive (Combined)

Avg. Prev. Freq (Combined)

Laboratory

Avg. Laboratory Freq

X-rays (Combined)

Avg. X-ray Freq (Combined)

X-rays (Specialist)

Avg. X-rays Freq (Specialist)

X-rays (Primary)

Avg. X-rays Freq (Primary)

X-rays (Unclass.)

Avg. X-rays Freq (Unclass.)

SNF

Avg. SNF Freq.

Unclassified

Avg. Unclassified Freq

Avg. IP Days

Avg. SNF Days

Mental Health - OP Facility

Avg. Mental Health - OP Facility Freq

Mental Health - OP Prof.

Avg. Mental Health - OP Prof. Freq

Imaging - OP Facility

Avg. Imaging - OP Facility Freq

Imaging - OP Prof.

Avg. Imaging - OP Prof. Freq

Speech Therapy - OP Facility

Avg. Speech Therapy - OP Facility Freq

Speech Therapy - OP Prof.

Avg. Speech Therapy - OP Prof. Freq

Occupational Therapy - OP Facility

Avg. Occ. Therapy - OP Facility Freq

Occupational Therapy - OP Prof.

Avg. Occ. Therapy - OP Prof. Freq

Laboratory - OP Facility

Avg. Lab - OP Facility Freq

Laboratory - OP Prof.

Avg. Lab - OP Prof. Freq

Unclassified - OP Facility

Avg. Unclass. - OP Facility Freq

OP Surgery

OP Surgery Freq

IP Max Days - 1

IP Max Days - 2

IP Max Days - 3

IP Max Days - 4

IP Max Days - 5

IP Max Days - 6

IP Max Days - 7

IP Max Days - 8

IP Max Days - 9

IP Max Days - 10

Primary Care >1 Visit

Primary Care >1 Visit Freq.

Primary Care >2 Visits

Primary Care >2 Visits Freq.

Primary Care >3 Visits

Primary Care >3 Visits Freq.

Primary Care >4 Visits

Primary Care >4 Visits Freq.

Primary Care >5 Visits

Primary Care >5 Visits Freq.

Primary Care >6 Visits

Primary Care >6 Visits Freq.

Primary Care >7 Visits

Primary Care >7 Visits Freq.

Primary Care >8 Visits

Primary Care >8 Visits Freq.

Primary Care >9 Visits

Primary Care >9 Visits Freq.

Primary Care >10 Visits

Primary Care >10 Visits Freq.

Silver Plans, Medical Only
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

ER

Avg. ER Freq

IP

Avg. IP Freq

Primary Care

Avg. Primary Care Freq

Specialist

Avg. Specialist Freq

Mental Health and Sub. Use Disorder

Mental Health and Sub. Use Disorder Freq.

Imaging

Avg. Imaging Freq

Speech Therapy

Avg. Speech Therapy Freq

Occ. + Physical Therapy

Occ. + Physical Therapy Freq

Preventive (Combined)

Avg. Prev. Freq (Combined)

Laboratory

Avg. Laboratory Freq

X-rays (Combined)

Avg. X-ray Freq (Combined)

X-rays (Specialist)

Avg. X-rays Freq (Specialist)

X-rays (Primary)

Avg. X-rays Freq (Primary)

X-rays (Unclass.)

Avg. X-rays Freq (Unclass.)

SNF

Avg. SNF Freq.

Unclassified

Avg. Unclassified Freq

Avg. IP Days

Avg. SNF Days

Mental Health - OP Facility

Avg. Mental Health - OP Facility Freq

Mental Health - OP Prof.

Avg. Mental Health - OP Prof. Freq

Imaging - OP Facility

Avg. Imaging - OP Facility Freq

Imaging - OP Prof.

Avg. Imaging - OP Prof. Freq

Speech Therapy - OP Facility

Avg. Speech Therapy - OP Facility Freq

Speech Therapy - OP Prof.

Avg. Speech Therapy - OP Prof. Freq

Occupational Therapy - OP Facility

Avg. Occ. Therapy - OP Facility Freq

Occupational Therapy - OP Prof.

Avg. Occ. Therapy - OP Prof. Freq

Laboratory - OP Facility

Avg. Lab - OP Facility Freq

Laboratory - OP Prof.

Avg. Lab - OP Prof. Freq

Unclassified - OP Facility

Avg. Unclass. - OP Facility Freq

OP Surgery

OP Surgery Freq

IP Max Days - 1

IP Max Days - 2

IP Max Days - 3

IP Max Days - 4

IP Max Days - 5

IP Max Days - 6

IP Max Days - 7

IP Max Days - 8

IP Max Days - 9

IP Max Days - 10

Primary Care >1 Visit

Primary Care >1 Visit Freq.

Primary Care >2 Visits

Primary Care >2 Visits Freq.

Primary Care >3 Visits

Primary Care >3 Visits Freq.

Primary Care >4 Visits

Primary Care >4 Visits Freq.

Primary Care >5 Visits

Primary Care >5 Visits Freq.

Primary Care >6 Visits

Primary Care >6 Visits Freq.

Primary Care >7 Visits

Primary Care >7 Visits Freq.

Primary Care >8 Visits

Primary Care >8 Visits Freq.

Primary Care >9 Visits

Primary Care >9 Visits Freq.

Primary Care >10 Visits

Primary Care >10 Visits Freq.

Bronze Plans, Medical Only
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

ER

Avg. ER Freq

IP

Avg. IP Freq

Primary Care

Avg. Primary Care Freq

Specialist

Avg. Specialist Freq

Mental Health and Sub. Use Disorder

Mental Health and Sub. Use Disorder Freq.

Imaging

Avg. Imaging Freq

Speech Therapy

Avg. Speech Therapy Freq

Occ. + Physical Therapy

Occ. + Physical Therapy Freq

Preventive (Combined)

Avg. Prev. Freq (Combined)

Laboratory

Avg. Laboratory Freq

X-rays (Combined)

Avg. X-ray Freq (Combined)

X-rays (Specialist)

Avg. X-rays Freq (Specialist)

X-rays (Primary)

Avg. X-rays Freq (Primary)

X-rays (Unclass.)

Avg. X-rays Freq (Unclass.)

SNF

Avg. SNF Freq.

Unclassified

Avg. Unclassified Freq

Avg. IP Days

Avg. SNF Days

Mental Health - OP Facility

Avg. Mental Health - OP Facility Freq

Mental Health - OP Prof.

Avg. Mental Health - OP Prof. Freq

Imaging - OP Facility

Avg. Imaging - OP Facility Freq

Imaging - OP Prof.

Avg. Imaging - OP Prof. Freq

Speech Therapy - OP Facility

Avg. Speech Therapy - OP Facility Freq

Speech Therapy - OP Prof.

Avg. Speech Therapy - OP Prof. Freq

Occupational Therapy - OP Facility

Avg. Occ. Therapy - OP Facility Freq

Occupational Therapy - OP Prof.

Avg. Occ. Therapy - OP Prof. Freq

Laboratory - OP Facility

Avg. Lab - OP Facility Freq

Laboratory - OP Prof.

Avg. Lab - OP Prof. Freq

Unclassified - OP Facility

Avg. Unclass. - OP Facility Freq

OP Surgery

OP Surgery Freq

IP Max Days - 1

IP Max Days - 2

IP Max Days - 3

IP Max Days - 4

IP Max Days - 5

IP Max Days - 6

IP Max Days - 7

IP Max Days - 8

IP Max Days - 9

IP Max Days - 10

Primary Care >1 Visit

Primary Care >1 Visit Freq.

Primary Care >2 Visits

Primary Care >2 Visits Freq.

Primary Care >3 Visits

Primary Care >3 Visits Freq.

Primary Care >4 Visits

Primary Care >4 Visits Freq.

Primary Care >5 Visits

Primary Care >5 Visits Freq.

Primary Care >6 Visits

Primary Care >6 Visits Freq.

Primary Care >7 Visits

Primary Care >7 Visits Freq.

Primary Care >8 Visits

Primary Care >8 Visits Freq.

Primary Care >9 Visits

Primary Care >9 Visits Freq.

Primary Care >10 Visits

Primary Care >10 Visits Freq.

Platinum Plans, Drug Claims Only
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

Generics

Avg. Generics Prescriptions

Preferred Brand

Avg. Pref. Brand Prescriptions

Non-Preferred Brand

Avg. Non-Pref. Brand Prescriptions

Specialty High-Cost

Avg. Spec. Prescriptions

Gold Plans, Drug Claims Only
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

Generics

Avg. Generics Prescriptions

Preferred Brand

Avg. Pref. Brand Prescriptions

Non-Preferred Brand

Avg. Non-Pref. Brand Prescriptions

Specialty High-Cost

Avg. Spec. Prescriptions

Silver Plans, Drug Claims Only
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

Generics

Avg. Generics Prescriptions

Preferred Brand

Avg. Pref. Brand Prescriptions

Non-Preferred Brand

Avg. Non-Pref. Brand Prescriptions

Specialty High-Cost

Avg. Spec. Prescriptions

Bronze Plans, Drug Claims Only
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

Generics

Avg. Generics Prescriptions

Preferred Brand

Avg. Pref. Brand Prescriptions

Non-Preferred Brand

Avg. Non-Pref. Brand Prescriptions

Specialty High-Cost

Avg. Spec. Prescriptions

Platinum Plans, All Claims
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

ER

Avg. ER Freq

IP

Avg. IP Freq

Primary Care

Avg. Primary Care Freq

Specialist

Avg. Specialist Freq

Mental Health and Sub. Use Disorder

Mental Health and Sub. Use Disorder Freq.

Imaging

Avg. Imaging Freq

Speech Therapy

Avg. Speech Therapy Freq

Occ. + Physical Therapy

Occ. + Physical Therapy Freq

Preventive (Combined)

Avg. Prev. Freq (Combined)

Laboratory

Avg. Laboratory Freq

X-rays (Combined)

Avg. X-ray Freq (Combined)

X-rays (Specialist)

Avg. X-rays Freq (Specialist)

X-rays (Primary)

Avg. X-rays Freq (Primary)

X-rays (Unclass.)

Avg. X-rays Freq (Unclass.)

SNF

Avg. SNF Freq.

Unclassified

Avg. Unclassified Freq

Avg. IP Days

Avg. SNF Days

Generics

Avg. Generics Prescriptions

Preferred Brand

Avg. Pref. Brand Prescriptions

Non-Preferred Brand

Avg. Non-Pref. Brand Prescriptions

Specialty High-Cost

Avg. Spec. Prescriptions

Mental Health - OP Facility

Avg. Mental Health - OP Facility Freq

Mental Health - OP Prof.

Avg. Mental Health - OP Prof. Freq

Imaging - OP Facility

Avg. Imaging - OP Facility Freq

Imaging - OP Prof.

Avg. Imaging - OP Prof. Freq

Speech Therapy - OP Facility

Avg. Speech Therapy - OP Facility Freq

Speech Therapy - OP Prof.

Avg. Speech Therapy - OP Prof. Freq

Occupational Therapy - OP Facility

Avg. Occ. Therapy - OP Facility Freq

Occupational Therapy - OP Prof.

Avg. Occ. Therapy - OP Prof. Freq

Laboratory - OP Facility

Avg. Lab - OP Facility Freq

Laboratory - OP Prof.

Avg. Lab - OP Prof. Freq

Unclassified - OP Facility

Avg. Unclass. - OP Facility Freq

OP Surgery

OP Surgery Freq.

IP Max Days - 1

IP Max Days - 2

IP Max Days - 3

IP Max Days - 4

IP Max Days - 5

IP Max Days - 6

IP Max Days - 7

IP Max Days - 8

IP Max Days - 9

IP Max Days - 10

Primary Care >1 Visit

Primary Care >1 Visit Freq.

Primary Care >2 Visits

Primary Care >2 Visits Freq.

Primary Care >3 Visits

Primary Care >3 Visits Freq.

Primary Care >4 Visits

Primary Care >4 Visits Freq.

Primary Care >5 Visits

Primary Care >5 Visits Freq.

Primary Care >6 Visits

Primary Care >6 Visits Freq.

Primary Care >7 Visits

Primary Care >7 Visits Freq.

Primary Care >8 Visits

Primary Care >8 Visits Freq.

Primary Care >9 Visits

Primary Care >9 Visits Freq.

Primary Care >10 Visits

Primary Care >10 Visits Freq.

Gold Plans, All Claims
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

ER

Avg. ER Freq

IP

Avg. IP Freq

Primary Care

Avg. Primary Care Freq

Specialist

Avg. Specialist Freq

Mental Health and Sub. Use Disorder

Mental Health and Sub. Use Disorder Freq.

Imaging

Avg. Imaging Freq

Speech Therapy

Avg. Speech Therapy Freq

Occ. + Physical Therapy

Occ. + Physical Therapy Freq

Preventive (Combined)

Avg. Prev. Freq (Combined)

Laboratory

Avg. Laboratory Freq

X-rays (Combined)

Avg. X-ray Freq (Combined)

X-rays (Specialist)

Avg. X-rays Freq (Specialist)

X-rays (Primary)

Avg. X-rays Freq (Primary)

X-rays (Unclass.)

Avg. X-rays Freq (Unclass.)

SNF

Avg. SNF Freq.

Unclassified

Avg. Unclassified Freq

Avg. IP Days

Avg. SNF Days

Generics

Avg. Generics Prescriptions

Preferred Brand

Avg. Pref. Brand Prescriptions

Non-Preferred Brand

Avg. Non-Pref. Brand Prescriptions

Specialty High-Cost

Avg. Spec. Prescriptions

Mental Health - OP Facility

Avg. Mental Health - OP Facility Freq

Mental Health - OP Prof.

Avg. Mental Health - OP Prof. Freq

Imaging - OP Facility

Avg. Imaging - OP Facility Freq

Imaging - OP Prof.

Avg. Imaging - OP Prof. Freq

Speech Therapy - OP Facility

Avg. Speech Therapy - OP Facility Freq

Speech Therapy - OP Prof.

Avg. Speech Therapy - OP Prof. Freq

Occupational Therapy - OP Facility

Avg. Occ. Therapy - OP Facility Freq

Occupational Therapy - OP Prof.

Avg. Occ. Therapy - OP Prof. Freq

Laboratory - OP Facility

Avg. Lab - OP Facility Freq

Laboratory - OP Prof.

Avg. Lab - OP Prof. Freq

Unclassified - OP Facility

Avg. Unclass. - OP Facility Freq

OP Surgery

OP Surgery Freq.

IP Max Days - 1

IP Max Days - 2

IP Max Days - 3

IP Max Days - 4

IP Max Days - 5

IP Max Days - 6

IP Max Days - 7

IP Max Days - 8

IP Max Days - 9

IP Max Days - 10

Primary Care >1 Visit

Primary Care >1 Visit Freq.

Primary Care >2 Visits

Primary Care >2 Visits Freq.

Primary Care >3 Visits

Primary Care >3 Visits Freq.

Primary Care >4 Visits

Primary Care >4 Visits Freq.

Primary Care >5 Visits

Primary Care >5 Visits Freq.

Primary Care >6 Visits

Primary Care >6 Visits Freq.

Primary Care >7 Visits

Primary Care >7 Visits Freq.

Primary Care >8 Visits

Primary Care >8 Visits Freq.

Primary Care >9 Visits

Primary Care >9 Visits Freq.

Primary Care >10 Visits

Primary Care >10 Visits Freq.

Silver Plans, All Claims
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

ER

Avg. ER Freq

IP

Avg. IP Freq

Primary Care

Avg. Primary Care Freq

Specialist

Avg. Specialist Freq

Mental Health and Sub. Use Disorder

Mental Health and Sub. Use Disorder Freq.

Imaging

Avg. Imaging Freq

Speech Therapy

Avg. Speech Therapy Freq

Occ. + Physical Therapy

Occ. + Physical Therapy Freq

Preventive (Combined)

Avg. Prev. Freq (Combined)

Laboratory

Avg. Laboratory Freq

X-rays (Combined)

Avg. X-ray Freq (Combined)

X-rays (Specialist)

Avg. X-rays Freq (Specialist)

X-rays (Primary)

Avg. X-rays Freq (Primary)

X-rays (Unclass.)

Avg. X-rays Freq (Unclass.)

SNF

Avg. SNF Freq.

Unclassified

Avg. Unclassified Freq

Avg. IP Days

Avg. SNF Days

Generics

Avg. Generics Prescriptions

Preferred Brand

Avg. Pref. Brand Prescriptions

Non-Preferred Brand

Avg. Non-Pref. Brand Prescriptions

Specialty High-Cost

Avg. Spec. Prescriptions

Mental Health - OP Facility

Avg. Mental Health - OP Facility Freq

Mental Health - OP Prof.

Avg. Mental Health - OP Prof. Freq

Imaging - OP Facility

Avg. Imaging - OP Facility Freq

Imaging - OP Prof.

Avg. Imaging - OP Prof. Freq

Speech Therapy - OP Facility

Avg. Speech Therapy - OP Facility Freq

Speech Therapy - OP Prof.

Avg. Speech Therapy - OP Prof. Freq

Occupational Therapy - OP Facility

Avg. Occ. Therapy - OP Facility Freq

Occupational Therapy - OP Prof.

Avg. Occ. Therapy - OP Prof. Freq

Laboratory - OP Facility

Avg. Lab - OP Facility Freq

Laboratory - OP Prof.

Avg. Lab - OP Prof. Freq

Unclassified - OP Facility

Avg. Unclass. - OP Facility Freq

OP Surgery

OP Surgery Freq.

IP Max Days - 1

IP Max Days - 2

IP Max Days - 3

IP Max Days - 4

IP Max Days - 5

IP Max Days - 6

IP Max Days - 7

IP Max Days - 8

IP Max Days - 9

IP Max Days - 10

Primary Care >1 Visit

Primary Care >1 Visit Freq.

Primary Care >2 Visits

Primary Care >2 Visits Freq.

Primary Care >3 Visits

Primary Care >3 Visits Freq.

Primary Care >4 Visits

Primary Care >4 Visits Freq.

Primary Care >5 Visits

Primary Care >5 Visits Freq.

Primary Care >6 Visits

Primary Care >6 Visits Freq.

Primary Care >7 Visits

Primary Care >7 Visits Freq.

Primary Care >8 Visits

Primary Care >8 Visits Freq.

Primary Care >9 Visits

Primary Care >9 Visits Freq.

Primary Care >10 Visits

Primary Care >10 Visits Freq.

Bronze Plans, All Claims
Continuance Table

Up To
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
$1,000
$1,100
$1,200
$1,300
$1,400
$1,500
$1,600
$1,700
$1,800
$1,900
$2,000
$2,100
$2,200
$2,300
$2,400
$2,500
$2,600
$2,700
$2,800
$2,900
$3,000
$3,100
$3,200
$3,300
$3,400
$3,500
$3,600
$3,700
$3,800
$3,900
$4,000
$4,100
$4,200
$4,300
$4,400
$4,500
$4,600
$4,700
$4,800
$4,900
$5,000
$5,100
$5,200
$5,300
$5,400
$5,500
$5,600
$5,700
$5,800
$5,900
$6,000
$6,100
$6,200
$6,300
$6,400
$6,500
$7,500
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$100,000
$200,000
$300,000
$400,000
$500,000
$1,000,000
$2,000,000
Unlimited

Number of Enrollees

Avg. Cost per Enrollee (Max'd)

Avg. Cost per Enrollee (Bucket)

ER

Avg. ER Freq

IP

Avg. IP Freq

Primary Care

Avg. Primary Care Freq

Specialist

Avg. Specialist Freq

Mental Health and Sub. Use Disorder

Mental Health and Sub. Use Disorder Freq.

Imaging

Avg. Imaging Freq

Speech Therapy

Avg. Speech Therapy Freq

Occ. + Physical Therapy

Occ. + Physical Therapy Freq

Preventive (Combined)

Avg. Prev. Freq (Combined)

Laboratory

Avg. Laboratory Freq

X-rays (Combined)

Avg. X-ray Freq (Combined)

X-rays (Specialist)

Avg. X-rays Freq (Specialist)

X-rays (Primary)

Avg. X-rays Freq (Primary)

X-rays (Unclass.)

Avg. X-rays Freq (Unclass.)

SNF

Avg. SNF Freq.

Unclassified

Avg. Unclassified Freq

Avg. IP Days

Avg. SNF Days

Generics

Avg. Generics Prescriptions

Preferred Brand

Avg. Pref. Brand Prescriptions

Non-Preferred Brand

Avg. Non-Pref. Brand Prescriptions

Specialty High-Cost

Avg. Spec. Prescriptions

Mental Health - OP Facility

Avg. Mental Health - OP Facility Freq

Mental Health - OP Prof.

Avg. Mental Health - OP Prof. Freq

Imaging - OP Facility

Avg. Imaging - OP Facility Freq

Imaging - OP Prof.

Avg. Imaging - OP Prof. Freq

Speech Therapy - OP Facility

Avg. Speech Therapy - OP Facility Freq

Speech Therapy - OP Prof.

Avg. Speech Therapy - OP Prof. Freq

Occupational Therapy - OP Facility

Avg. Occ. Therapy - OP Facility Freq

Occupational Therapy - OP Prof.

Avg. Occ. Therapy - OP Prof. Freq

Laboratory - OP Facility

Avg. Lab - OP Facility Freq

Laboratory - OP Prof.

Avg. Lab - OP Prof. Freq

Unclassified - OP Facility

Avg. Unclass. - OP Facility Freq

OP Surgery

OP Surgery Freq.

IP Max Days - 1

IP Max Days - 2

IP Max Days - 3

IP Max Days - 4

IP Max Days - 5

IP Max Days - 6

IP Max Days - 7

IP Max Days - 8

IP Max Days - 9

IP Max Days - 10

Primary Care >1 Visit

Primary Care >1 Visit Freq.

Primary Care >2 Visits

Primary Care >2 Visits Freq.

Primary Care >3 Visits

Primary Care >3 Visits Freq.

Primary Care >4 Visits

Primary Care >4 Visits Freq.

Primary Care >5 Visits

Primary Care >5 Visits Freq.

Primary Care >6 Visits

Primary Care >6 Visits Freq.

Primary Care >7 Visits

Primary Care >7 Visits Freq.

Primary Care >8 Visits

Primary Care >8 Visits Freq.

Primary Care >9 Visits

Primary Care >9 Visits Freq.

Primary Care >10 Visits

Primary Care >10 Visits Freq.