How is a member’s historic claims experience used to adjust the basic contribution?
In assessing a member’s claims experience, their actual experience to date is compared against the expected experience based on the risk profile used to calculate the basic contribution. That is, the risk profile based on the number, clinical specialty and grades of WTEs, and the number of births. This comparison is done separately for the obstetric and general claims experience. This comparison of actual claims with expected claims is based on two measures; the total value of claims and the total number of claims. It is important to take account of both these measures to be sure that a member’s claims history is materially different from what is expected before applying an experience rating. For example, a member’s expected claims experience may be ten claims totalling £1.0m. However, the member has actually had one claim of £1.5m. Is the experience good or bad? There are fewer claims by number than expected but the total value of the claims is greater than expected. In this particula
