Page 6 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

2.4.2 FULLY INSURED .................................................................................................................... 48

2.4.3 RISK SHARING ....................................................................................................................... 48
2.4.4 COST PLUS PLANS ................................................................................................................ 49

2.4.5 SELF-FUNDING ..................................................................................................................... 49

2.4.6 CO-FUNDING ........................................................................................................................ 50
TUTORIAL .................................................................................................................................................. 51

3.1 ASSESSMENT AND UNDERWRITING ....................................................................................... 52
3.1.1 PRINCIPLES OF ASSESSMENT AND UNDERWRITING ................................................... 52

3.1.2 AN EXAMPLE ON PREMIUM LOADING AFTER A CLAIM ............................................. 53
3.1.3 HOW PREMIUMS ARE CALCULATED ............................................................................... 54

3.1.4 MEDICAL UNDERWRITING AND OTHER RISK ASSESSMENT ...................................... 60
3.1.5 MORATORIA UNDERWRITING .......................................................................................... 61

3.2 COST CONTAINMENT ................................................................................................................. 63
3.2.1 NO CLAIM DISCOUNT SCHEMES ...................................................................................... 63

3.2.2 LOYALTY DISCOUNTS .......................................................................................................... 64

3.2.3 PAYMENT METHOD DISCOUNTS ..................................................................................... 65
3.2.4 EXCESSES ............................................................................................................................... 65

3.2.5 GOOD EXPERIENCE REFUND SCHEME ............................................................................ 66
3.2.6 CO-INSURANCE .................................................................................................................... 67

3.2.7 BENEFIT LIMITS .................................................................................................................... 67
3.2.8 EXCLUSIONS .......................................................................................................................... 69

3.2.9 PROVIDER NETWORKS ....................................................................................................... 70

TUTORIAL .................................................................................................................................................... 72
INTRODUCTION ........................................................................................................................................... 73

4.1 CONSIDERATION ................................................................................................................................... 73
4.1.1 PRE-EXISTING CONDITIONS ..................................................................................................... 74

4.1.2 ACUTE ILLNESS AND CHRONIC ILLNESS ................................................................................... 74
4.2 UNDERWRITING MEDICAL HISTORY ..................................................................................................... 75

4.2.1 MEDICAL UNDERWRITING ........................................................................................................ 76
4.3 UNDERWRITING CONSIDERATIONS FOR GROUP MEDICAL INSURANCE POLICY .................................. 78

4.3.1 PROVIDER NETWORK ............................................................................................................... 78
4.3.2 PAST CLAIMS EXPERIENCE ....................................................................................................... 79

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