Milliman's Health Cost Guidelines™ incorporate over 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 More than 100 insurers rely on our proprietary methodologies and comprehensive data, compiled from published and unpublished, private and public data sources, to adjust national average healthcare costs for specific geographic areas, benefits, reimbursement structures, and plan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.

The Health Cost Guidelines cover the latest trends and deliver 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 over 21 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

The Health Cost Guidelines include seven manuals available in electronic format. Health Cost Guidelines—Commercial, which combines the Commercial Rating Structures, Commercial Area Factors, and Claim Probability Distributions, provides the essential factors for evaluating pricing relative to benefit plans, and geographic areas. Also included with a Commercial Health Cost Guidelines license are the Prescription Drug Rating Model and Managed Care Rating Model, automated worksheets for calculating pricing estimates. Milliman also publishes the Health Cost Guidelines—Ages 65 and Over, Health Cost Guidelines—Dental, and the Health Cost Guidelines—Reinsurance manuals, which provide the factors, rating models, and values needed to allow insurers to drill down into specific pricing issues for those lines of business.