How to understand Yuzu's Aggregate report.
Purpose and Availability
Aggregate reports are specific to a Group Policy (e.g. one sponsor and one plan year) but incorporate information about multiple plans. The purpose of the Aggregate report is to help the TPA file aggregate stoploss claims, although since the report has overall information about how the plan is performing, it is valuable to employers and brokers too.
You can view the Aggregate report at https://portal.yuzu.health/group/${id}/reports.
The report has all claims information, including claims paid for by the spec policy.
Definitions
- Plan-Level Claims Paid = claims associated with admin fees which count toward the Agg and not the Spec (e.g. PBM Admin fees , DPC Ancillary fees, Network Retainage fees)
- Total Claims Paid = Plan-Level Claims Paid + Medical Claims Paid + Pharmacy Claims Paid
- Claims Over Spec = dollars paid beyond member’s specific deductible
- Rebates Received = dollars received as PBM rebates
- Out of Policy Claims = dollars paid outside of stoploss policy (e.g. employer or plan exceptions)
- Total Agg Adjustments = Claims Over Spec + Rebates Received + Out of Policy Claims
- Agg (Surplus) Deficit = Total Claims Paid - Attachment Point - Total Agg Adjustments (negative denotes employer surplus)
- PTD Agg (Surplus) Deficit = Agg (Surplus) Deficit but cumulative plan-to-date (“PTD”)
- PTD % of Attachment Point (Net Loss Ratio) = (Total Claims Paid - Total Agg Adjustments) / PTD Attachment Point