The Easy Guide to Actuarial Value

How Health Insurance Works $ Health Insurer $ Premiums Claims Payments

Some people cost a lot… $ $ $ $ $ $ $ $ …and some cost a little

Insurance pays different amounts for different people $ $ $ $ $ $ $ $ NO insurance payment; deductible not met BIG insurance payment; patient hit out-of-pocket maximum

$ $ $ $ $ $ $ $ The Average of what insurance pays is Actuarial Value 75%

$ $ $ $ $ $ $ $ But not just any “average” 85% 45%

$ $ $ $ $ $ $ $ Actuarial Value is the average of a Standard Population of both sick and healthy enrollees 75%

$ $ $ $ $ $ $ $ What the plan pays for YOU, could be more or less than that average. 75% Plan paid nothing for this person Plan paid a lot for this person