Page 48 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

2.4.1 INDIVIDUAL AND GROUP SCHEMES

Individual products are generally standard products, offered by insurers,
off the shelf, with predetermined benefits as set out in the plan. The

premium charged is individually rated according to the gender and age of

entry. The plan offered may extend to cover immediate family, that is,

spouse and children and the premium is paid by the individual.

The premium of the individual product will be adjusted:

a) by age, as it is on the increasing band of the age

b) by claims utilisation, as the Insurer will impose a loading upon renewal,
for a yearly renewal policy, if the claim experience of the Insured is not

favourable

c) by portfolio rating; premium will be adjusted for all Insureds within the

portfolio of the product, and this is applicable to guaranteed renewal
products.

Group schemes are generally categorised into small groups and large

groups depending on the size of the group. The premium is usually paid by

the employer and is also part of the Employee Benefit Scheme. The

dependants of the employees may also be included to enjoy the group

scheme benefits.

Premium rating and adjustment can be as follows:

a) Experience rating - the group claims experience is collated over a period
of twelve months or more to determine the group trend, including other

factors of group size and special coverage. The premium will be calculated

according to the group claims experience.

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