[Code of Federal Regulations]
[Title 48, Volume 6]
[Revised as of October 1, 2003]
From the U.S. Government Printing Office via GPO Access
[CITE: 48CFR1602.170-5]

[Page 119]
 
            TITLE 48--FEDERAL ACQUISITION REGULATIONS SYSTEM
 
  CHAPTER 16--OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH 
                     BENEFITS ACQUISITION REGULATION
 
PART 1602--DEFINITIONS OF WORDS AND TERMS--Table of Contents
 
               Subpart 1602.1--Definitions of FEHBP Terms
 
Sec. 1602.170-5  Cost or pricing data.

    (a) Experience rated carriers. Cost or pricing data for experience 
rated carriers includes information such as claims data; actual or 
negotiated benefits payments made to providers of medical services for 
the provision of health care such as capitation not adjusted for 
specific groups, per diems, and Diagnostic Related Group (DRG) payments; 
cost data; utilization data; and administrative expenses and retentions.
    (b) Community rated carriers. Cost or pricing data for community 
rated carriers is the specialized rating data used by carriers in 
computing a rate that is appropriate for the Federal group and the 
similarly sized subscriber groups (SSSGs). Such data include, but are 
not limited to, capitation rates; prescription drug, hospital, and 
office visit benefits utilization data; trend data; actuarial data; 
rating methodologies for other groups; standardized presentation of the 
carrier's rating method (age, sex, etc.) showing that the factor 
predicts utilization; tiered rates information; ``step-up'' factors 
information; demographics such as family size; special benefit loading 
capitations; and adjustment factors for capitation.

[62 FR 47574, Sept. 10, 1997]