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Milliman Health Cost Guidelines Suite
Incorporating more than 60 years of research and consulting, the Milliman Health Cost Guidelines are compiled from published, unpublished, private, and public data sources. Today, risk-bearing entities rely on our proprietary methodologies and comprehensive data to:
In addition to being comprehensive, the Guidelines are flexible enough to accommodate your specific situation. Whether the focus is on a single benefit area, such as prescription drugs, or redesigning an entire benefit plan, the Guidelines will keep you up to date on the issues that affect your bottom line.
The Health Cost Guidelines are updated annually to address the latest trends and regulatory compliance issues.
Milliman uses multiple sources of public and private data sources to produce the most comprehensive Health Cost Guidelines available.
The products we sell are the tools we use. As the premier healthcare management consulting firm, Milliman uses the Health Cost Guidelines and underlying data daily to give our in-house actuarial consultants longitudinal insight into the key drivers of healthcare costs and utilization.
The Health Cost Guidelines–Commercial include the Commercial Rating Structures, Commercial Area Factors, Commercial Claim Probability Distributions, Managed Care Rating Model (MCRM), and Prescription Drug Rating Model (RxRM).
The Rating Structures are used to determine utilization, charge levels, and claim costs for various health benefits. The Area Factors are used with the Rating Structures to geographically adjust national average costs. Claims Probability Distributions help assess value of deductibles, out-of-pocket maximums, and the effect of plan maximums and area factors by deductible level. The two rating models automate the input and calculation of many of the rating variables and worksheets described in the managed care and prescription drug rating structures.
The Health Cost Guidelines—Ages 65 and Over are used to adjust national average costs to specific geographic areas and to rate Medicare Advantage, Medicare Supplement, and retiree medical plans. They provide a basis for calculating prescription drug claim costs and allow for modifying costs based on age/gender mix, geographic area, trends, and other rating factors.
The Dental Cost Guidelines allow you to:
Anticipate future claim levels, evaluate historical data, and establish relationships between health coverage levels using the Milliman Health Cost Guidelines—Reinsurance. These guidelines contain rating structures for reinsurance used with fee-for-service or managed care plans provided to commercial or Medicare enrollees.
Analyze and benchmark utilization and costs using the Health Cost Guidelines—Grouper, software which sorts medical and pharmacy claims data into hospital, surgical, medical, and other benefit service categories using Health Cost Guidelines (HCG) definitions.
Determine claim costs for a wide variety of prescription drug benefit plans for either commercial, Medicare or retiree populations. The rating manual allows you to:
The Individual and Small Group Medical Underwriting Guidelines (MUGs) are evidence-based tools for underwriters to assess relative risk based on applicants’ medical and prescription drug histories, helping to determine coverage costs. Key features include:
Streamline condition and rating searches, accelerate quotes, and enhance accuracy with web-based Medical Underwriting Guidelines (WebMUGs). Traditional manual underwriting processes can be error-prone and may lack the precision for accurate predictions. WebMUGs offers an easily searchable MUGs manual, eliminating the need to flip through physical documents. With WebMUGs, actuaries and underwriters can concentrate on higher-value tasks and refine underwriting using up-to-date data.
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Manage Medicare, Medicaid, and commercial risk adjustment with our award-winning suite of tools and data.
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