Medical underwriting suite

Milliman has developed and made available a suite of products, to support and enhance risk selection at each step of the underwriting process: Initial underwriting• Individual Medical Underwriting Guidelines™ (IMUGs™)• Small Group Medical Underwriting Guidelines™ (SGMUGs™) Renewal underwriting• RenewalMUGs™: Claims-based renewal medical underwriting engine Online initial underwriting• WebMUGs™: Web-based version of the IMUGs and SGMUGs Prescription drug history information • IntelliScript® The Individual and Small Group Medical Underwriting Guidelines applications. RenewalMUGs uses claim, pharmacy, premium, and The Small Group Medical Underwriting Guidelines (SGMUGs) enrollment information to identify the conditions and relative health are tailored for small group underwriting, whereas the Individual Medical Underwriting Guidelines (IMUGs) are intended for the individual market. These are two separate MUGs products. The two The RenewalMUGs software package is designed to provide products are structurally the same. However, in order to reflect the maximum flexibility and convenience. Data source files can be in any more detailed information available to underwriters for individual one of three formats (text, Access, or SQL). The data input structures products, the IMUGs include information about exclusion riders are well defined and make it easy to map source data to standard and more detailed testing results and development information than structures. Standard reports are produced in Excel for maximum flexibility, and a series of output files can be easily accessed for detailed reporting. Web-based demonstrations are available.
The MUGs are a reference tool used at the time of initial underwriting, to allow underwriters to review the information available for each applicant The RenewalMUGs software enables the underwriter to track and assign relative risks, in the form of assigning debit points. The debit member-specific conditions from the time of application to renewal. points then are converted into relative risk scores, which plans use to This allows for better first-year renewal rating. With RenewalMUGs, determine what specific rating action should be taken.
it’s easy for the underwriter to review member-specific conditions and debits. RenewalMUGs is calibrated for each client to ensure that the health status load factors complement the manual rating While the MUGs are used for initial underwriting, the RenewalMUGs variables, such as age/gender factors and family size categories. are used for renewal underwriting risk assessment. The Utilizing three years of data, RenewalMUGs calculates each RenewalMUGs are based on the MUGs and assess health member’s months of coverage, and adjusts the member’s debit score status using claim data, rather than information from underwriting WebMUGs is a full-featured Internet-based underwriting tool allowing IntelliScript is an Internet-based service that gathers prescription underwriters to easily search all content within the MUGs, as well as histories for underwriters. The underwriter gets authorization from input and track underwriting information to help automate the process applicants in advance, and results are delivered to the underwriter of determining a final risk profile for each group or applicant. It contains via the Internet within seconds. This facilitates better and faster all the information included in the IMUGs and SGMUGs, and is helpful underwriting decisions. This instant underwriting intelligence for streamlining the efficiency and ease of initial underwriting.
enables automation as well as faster and more effective underwriting decisions.
WebMUGs can increase efficiency and maximize underwriting sophistication by simplifying condition and rating look-ups and debit IntelliScript reduces the need for obtaining further medical point assignment. The web-based system can quickly show the records or follow-up, provides additional information that rating impact of excluding certain conditions and/or members, and facilitates improved decisions, and ensures more consistent meets compliance requirements for documentation of underwriting decisions across a range of underwriter experience. decisions, which are satisfied by maintaining electronic records of each group/application.
How does it work?1. Applicants provide a HIPAA-compliant authorization to access WebMUGs can also produce detailed reports, including information 2. Insurers submit queries electronically to IntelliScript ƒ Most frequent conditions for a selected time period 3. IntelliScript gathers information from its data sources ƒ Average debit points assigned by group and by group size (SGMUGs) or family member and family combined (IMUGs) 4. Results are organized and delivered online to the underwriter ƒ Points assigned for height and weight (physical build) versus ƒ Presentation is tailored to insurer’s preferences ƒ Results are displayed in a color-coded graphical timeline ƒ Health condition detail by member for a selected group/application ƒ Details include drug name, dosage, fill date, pharmacy, and ƒ Debits assigned to members based on health conditions, prescription use, physical build, and tobacco use ƒ Comprehensive workflow management capabilities are included WebMUGs also allows for the easy exporting of all initial underwriting information, for use in other internal reporting purposes as well as providing web service interfaces for integration with external census and rating systems.
Many health plans already have an experienced underwriting and actuarial staff and are well- positioned to implement the MUGs. We will work with your group to help provide training and other Review Information to Assign Debit Points Stroke, Cerebral
Underwriters use information about the medical and prescription The symptom complex resulting from hemorrhage into or upon drug history of an individual or group to assign a total number of the brain or from embolism or thrombosis of the cerebral vessels, debit points. Debit points represent the estimated average cost consisting of sudden onset of coma, paralysis, aphasia, etc. If small for the first 12 months of coverage for an individual with a given area involved, symptoms may be transient, if larger the result usually condition relative to those without the condition.
Each medical condition listed in the condition ratings section of the MUGs may contain some or all of the information that is 2. Residual effect.
3. Underlying disease or cause if known.
Once an individual’s or group’s health data is evaluated, health plans can determine the appropriate underwriting action based on the debit points assigned. The approach used to calculate the average debit points per group should be consistent with the way Based on evaluation of the individual’s or group’s health risk using the MUGs debit point system, underwriters may take one of the following actions, based on thresholds determined by the plan. (Note: Some of these actions may be limited by state or ƒ Classify the individual or group as a preferred risk ƒ Classify the individual or group as a non-preferred risk ƒ Classify the individual as a preferred risk with coverage for ƒ Classify the individual as a non-preferred risk with coverage for Rx: LOSARTAN POTASSIUM/HYDROCHLOROTHIAZIDE Acceptance and rating criteria will vary by the insurer’s rating philosophy and perhaps by state and federal regulation. NOTE: If Transient Ischemic Attack (TIA) is also present, rate only for Stroke, Cerebral.
Rate for underlying disease if known (diabetes, arteriosclerosis, etc.), and any resulting paralysis.
Milliman is among the world’s largest independent actuarial and consulting firms. Founded in 1947 as Milliman & Robertson, the company currently has 53 offices in key locations worldwide. Milliman employs more than 2,500 people. The firm has consulting practices in healthcare, employee benefits, property & casualty insurance, life insurance and financial services. Milliman serves the full spectrum of business, financial, government, union, education and nonprofit organizations. For further information, visit
For more information, contact your Milliman consultant or visit


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