Select a state and issuer to view Worksheet 1
2026 Plan Year · Individual Market · Single Risk Pool
Submission Complete
Experience Member Months
Single risk pool, experience period
Projected Member Months
Filed plan year projection
Market Adj. Index Rate
PMPM — projected plan year
DevelopmentRate Development Waterfall
Part 1 — Experience Period Claims to Projected Index Rate
Start / End
Increase
Decrease
Credibility blend
Dollar amounts show PMPM impact of each step. Dashed connectors show the running total between bars.
Part 2 — Projected Index Rate to Market Adjusted Index Rate
Start / End
Increase
Decrease
Exchange fee gross-up
Exchange user fee shown as a gross-up — issuers price to recover fee revenue, increasing the index rate rather than treating it as a deduction.
Cost & Utilization Trends by Service Category (Annualized)
Annualized Cost Trend
Annualized Utilization Trend
Annualized trend = √(Yr1 × Yr2), the geometric mean of the two annual factors. Bars below zero indicate a negative trend for that component.
Service Category — Experience Index Rate vs. Trended EHB Claims PMPM
Exp. Index Rate PMPM
Trended EHB Claims PMPM
Difference between bars reflects applied cost and utilization trends by service line, before other adjustments.
Section IExperience Period Data
| Total ($) | PMPM ($) | |
|---|---|---|
| Allowed Claims | ||
| Reinsurance | ||
| Incurred Claims | ||
| Risk Adjustment Transfer | ||
| Experience Period Premium |
Section IIIndex Rate Development — Experience Period Rates & Trends
| Category | Exp. Index Rate PMPM | Yr 1 Cost Trend | Yr 1 Util Trend | Yr 2 Cost Trend | Yr 2 Util Trend | Trended EHB Claims PMPM |
|---|
AdjustmentsOther Modifications
| Morbidity Adjustment | |
| Demographic Shift | |
| Plan Design Changes | |
| Other | |
| Adjusted Trended EHB Claims PMPM |
CredibilityBlending & Projected Index Rate
| Manual EHB Claims PMPM | |
| Applied Credibility % | |
| Projected Index Rate PMPM | |
| Projected Index Rate Total |
Market AdjustmentsFrom Projected Index Rate to Market Adjusted Index Rate
ItemPMPM ($)Total ($)
Projected Index Rate
Reinsurance
Risk Adjustment Payment / Charge
Exchange User Fees (%)—
Projected Member Months
Market Adjusted Index Rate
Actual Result
Risk Adjustment — Projected vs Actual (CMS Final Report)