- Regression models predict expected claims cost by member group, plan design and region from the claims, enrollment and plan data you already hold.
- A second model estimates how price changes move plan choice and renewal, so pricing and retention are set together.
- Every model is explainable, with reason codes and model documentation your actuaries can review and defend.
- Your actuaries still set and sign every rate; the models give them a faster, better-tested starting point.
Every rate cycle starts from a spreadsheet
Price a plan too high and members move to a competitor at renewal. Price it too low and you attract risk the premium does not cover.
Your actuaries rebuild pricing models by hand each cycle, often with a few trusted variables and a lot of manual adjustment. That limits how many plan designs, regions and member groups they can test before the filing deadline.
How healthcare plan pricing works
Step 1: Connect the history
Pull claims, enrollment, plan design and renewal outcomes from the systems you already run.
Step 2: Model expected cost
H2O Driverless AI runs automatic feature engineering and compares generalized linear models with gradient boosting and other model types on held-out years.
Step 3: Model plan choice
A second model estimates how members respond to price and plan changes at renewal.
Step 4: Explain every model
Reason codes and model documentation show which factors drive each prediction, for actuarial review and regulator questions.
Step 5: Test scenarios
Compare premium options by plan and region on predicted cost and predicted retention before your actuaries choose.
Keeping generalized linear models in the mix
H2O Driverless AI includes generalized linear models alongside gradient boosting and other model types, ranked on the same held-out data, so your team can keep a GLM where transparency matters most.
Governance for member data
Protected health information never has to leave your boundary, and model documentation gives your compliance and actuarial teams a record of how each model was built and tested.