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Form 5500 Schedule A, Part III, what is the meaning of experience-rated?


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I am having difficulty interpreting part III. What is a lay-man's understanding of the difference between part 9 experience rated and part 10 non-experience rated? Are experience-rated fully insured while non-experience rated self insured?

Many thanks!

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There are 2 methods of developing the cost of claims in a plan.  Experience rated is a method whereby the groups actual claims experience is used to calculate the next years expected claim cost.  The larger the group enrollment the more predictable the claim experience. Non experienced is a method that does not take into account the actual claim experience of the group, rather it uses the carriers pool or book rates.  

Self funding is not the same, it is a method to fund the plan.  Self funding transfers some/all of the risk to the plan sponsor.  As a general rule, self funding uses “experienced-rated” costs, but in recent years you can find level Funded self funded plans utilizing non-experience rated costs.  A fully insured plan can have both experience and non-experienced rated.

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