Milliman's Health Cost Guidelines™ incorporate 50 years of research and consulting practice into an industry gold standard used by insurers, managed care organizations, and third-party administrators to estimate expected claim costs and model health care utilization. More than 100 insurers rely on our proprietary methodologies and comprehensive data, compiled from published and unpublished, private and public data sources, to adjust national average healthcare costs for specific geographic areas, benefits, reimbursement structures, and plan characteristics.

Health Cost Guidelines cover the latest trends and delivers deep research. Our annually updated guidelines bring $2 million of yearly investment in thorough, up-to-date research to the desks of health insurers. Milliman utilizes a database of full medical (hospital, physician, and supplies) and prescription drug claims experience for 17 million lives as a primary source in developing these guidelines. Other sources include a database of inpatient admissions that represent 75% of the national total.

The expertise you need to evaluate pricing

Health Cost Guidelines include seven volumes, which can be leased separately or in combinations and are available in electronic and printed formats. Health Cost Guidelines—Commercial, which combines Commercial Rating Structures; Commercial Area Factors, and Claim Probability Distributions—provide the essential factors of evaluating pricing relative to benefit plans, probability, and geographic areas. The electronic format of this Guide also includes our Prescription Drug Rating Model and Managed Care Rating Model, automated worksheets for calculating pricing estimates. Milliman also publishes three in-depth guides: Health Cost Guidelines-Dental, Health Cost Guidelines-Reinsurance, and Health Cost Guidelines-Ages 65 and Over, that allow insurers to drill down into specific pricing issues.