4.6 Paid Claims Distribution
The Paid Claims Distribution report groups members into one of fifteen expense bands ranging from $0 to $1 million based on plan spending. The report shows the number of members who incurred claims and the associated dollar cost..
The chart plots the percentage of members(light blue) against the percentage of total plan expenditure(black) for each expense band.
The following fields are given for each expense band:
Expense Band: One of ten expense increments used to indicate the amount paid per each claimant.
# of Claimants: The total number of claimants (members) whose plan expense fell within the corresponding expense band.
% of Total Claimants: The percentage of claimants (members) whose plan expense fell within the corresponding expense band. This is calculated by dividing the # of Claimants by the total number of covered claimants.
Plan Paid: The total amount paid by the Plan Sponsor in the corresponding expense band.
% of Usage: The percentage of total dollars paid by the Plan Sponsor. This is a measure of how much of total payment went to a specific item and is a useful indicator of how the plan dollars are distributed between expense bands.
Cumulative % Usage: The cumulative percentage of total dollars paid by the Plan Sponsor at the corresponding expense band.
Cumulative Paid: The cumulative total amount paid by the Plan Sponsor on members in corresponding expense band.
Helpful Hints:
Determines what percentage of the population is well, low risk, moderate risk, high risk, or likely involved in complex care.
Reiterates the 80/20 rule - 20% of the employee population make up 80% of the claims. The cumulative usage and paid values can be used to see how closely the plan follows this general trend.