Page 80 - MEDICAL AND HEALTH INSURANCE

MEDICAL AND HEALTH INSURANCE

Hence, it is a willing buyer and willing seller for those who can afford to enjoy the

facilities offered by the private provider.

In group medical underwriting, if there is a request for certain high-end providers
that are not within the insurer's panel list, the insurer may give special

consideration and price it accordingly.

4.3.2 PAST CLAIMS EXPERIENCE

 Most group medical underwriting is based on past claims experience to
underwrite, which is also termed as 'experience rating'.

 It is important for the underwriter to analyse the past trend and to be able to

project the future trend of the claims for the group.
 Such trend projection is a skill, based on the experience of the underwriter

and, of course, the group distribution, its morbidity rate, severity of the

claim, and their preferred provider network.

 If the loss is high, the premium would be adjusted to cater for the loss, taking

into consideration the future medical inflation and the administrative
charges and profit margin in underwriting the scheme.

 Similarly, if the losses are low the group premium rating would likely be

adjusted to reflect favourable past claims experience.

4.3.3 HEALTH, WELLNESS, OCCUPATIONAL, AND SAFETY COMPLIANCE

 Some group policyholders do take care of their employees' state of health

and wellness in their workplace.

 In most big group companies, all employees are subject to a pre-
employment check- up and must be suitable for employment before

employment is offered. In this instance, if the group is insuring the

employees, all the employees would have been screened for major illness
and be less likely to incur a claim during the first year of cover.

79 | P a g e