Conrad Calitz, Sarvesh Maharaj

Presentation

17 October 2017 | 10:50 – 11:50 | Bill Gallagher Room

Relevant practice area(s):Short-term Insurance, Data Analytics

Suggested audience knowledge level: Intermediate

Abstract:

 

The Medical Schemes act prevents Medical Schemes from performing various rating and underwriting actions that Short-Term Insurers are allowed to perform. These limitations placed on Medical Schemes include community rating, limited underwriting and minimum cover provided as per the Prescribed Minimum Benefits.

The factors mentioned above have put tremendous strain on Medical Schemes who are under pressure to keep contributions low in order to increase membership.This has necessitated the development and implementation of sophisticated methods to manage risk, such as:

Provider profiling;

Parts baskets analyses;

Risk based capitation agreements;

Pre-Authorisation;

Case Management; and

Preventative benefits.

This can be contrasted with the Short-Term Insurers who have considerable pricing flexibility. In addition, underwriters also have various risk mitigations available to them including: increasing excesses, excluding benefits, cancelling and declining cover.

Our presentation will illustrate how these sophisticated techniques developed for healthcare can be used in the short-term industry to reduce cost and ultimately lead to better experience for clients.