Document ID: chunk:federal_register_of_legislation:F2023L00723:front:0:p4
Version: federal_register_of_legislation:F2023L00723
Segment Type: other
Provision Reference: 
Character Range: 8364–13308

accrued premium after the Adverse Event Stress (AES), as defined in HPS 115, for that month.
Accrued premium (CE) amount    This is the central estimate (CE) forecast of accrued premium for that month.
Accrued premium (MA) amount    The insurer is required to report this item for months 10, 11 and 12 only. For health insurance business (HIB), this is to be determined by adjusting accrued premium (AES) amount for management actions (MA), as defined in HPS 115. For health-related insurance business (HRIB), this is to be reported as the accrued premium (CE) after allowing for management actions, as defined in HPS 115.

                               Accrued premium (MA) must reflect management actions that are appropriate and justified and comply with HPS 115. Management actions should reflect the insurer's expectations and not be limited to the extent that these result in insurance profits. This constraint will be applied separately in insurance profits forecast after management actions amount.

                               For months 1 to 9 inclusive, this is a derived item.

                               For HIB, this is equal to accrued premium (AES) amount. For HRIB, this is equal to accrued premium (CE) amount.

B
Benefits incurred (AES) amount                             This is a derived item.

                                                            For hospital treatment, this item is calculated as the sum of:
                                                                * claims incurred (AES) amount;
                                                                * calculated deficit (AES) amount; and
                                                                * state levies (AES) amount.
                                                           Less:
                                                                * gross deficit (AES) amount.
                                                           For general treatment, this item is equal to claims incurred (AES) amount.
Benefits incurred (CE) amount                              This is a derived item.

                                                           For hospital treatment, this item is calculated as the sum of:
                                                                * claims incurred (CE) amount;
                                                                * calculated deficit (CE) amount; and
                                                                * state levies (CE) amount.
                                                           Less:
                                                                * gross deficit (CE) amount.
                                                           For general treatment and health-related insurance business, this item is equal to claims incurred (CE) amount.
Benefits incurred (MA) amount                              This is a derived item.

                                                            For hospital treatment, this item is calculated as the sum of:
                                                                * claims incurred (MA) amount;
                                                                * calculated deficit (MA) amount; and
                                                                * state levies (MA) amount.
                                                           Less:
                                                                * gross deficit (MA) amount.
                                                           For general treatment and health-related insurance business, this item is equal to claims incurred (MA) amount.
Benefits incurred (pre-MA) amount                          This is a derived item, which provides an approximation of benefits incurred, following the Prescribed Benefit Stress to benefits incurred and management expenses in accordance with HPS 115.

                                                           For hospital treatment and general treatment, this item is calculated as:

                                                             *

                                                           Where:
                                                           A equals Benefits incurred (AES) amount
                                                           B equals HIB stress %

                                                           For health-related insurance business, this item is calculated as:

                                                             *
                                                           A equals Benefits incurred (CE) amount
                                                           B equals HRIB stress %
                                                           For general treatment and health-related insurance business, this item is also equal to claims incurred (pre-MA) amount.
Billed