The lnsurance Commission (lC) has announced the start of the first industry-wide morbidity study among all insurance companies selling health insurance products as well as all Health Maintenance Organisations (HMOs).
All data and reportorial requirements shall be submitted to the lC Actuarial Division on or before 30 November 2024.
The study, a joint initiative with the Actuarial Society of the Philippines (ASP), will cover lndividual, family and group/corporate products. The study parameters are as follows:
1. Period of Study: 1 January 2018 to 31 December 2022
2. Type of Processing: Seriatim (record-by-record)
3. Policy Data (Membership Data) Required: Policy (Membership) in-force record as of yearend in the calendar years indicated under the period of study
4. Claims Data Required: Claims incurred by those included in the policy data.
The study will be carried out in accordance with the Memorandum of Understanding signed by lC and ASP on 24 January 2024.
Aims
The objectives of the study are:
1. To develop industry-level health or medical claim costs and utilisation rates which can serve as benchmarks for the lC in evaluating the reasonableness of rate filings and reserve valuations of insurers and HMOs. This would promote fairness and strengthen consumer protection and prudential regulation.
2. To provide insurers and HMOs with industry-level experience which can be used as a benchmark for developing and pricing new health products and benefits.
3. To create credible data that are relevant and specific to the Philippine experience which would lessen dependence on data or experience of other countries which may not represent local conditions.
4. To provide information and insights which could aid the government in health policymaking.
5. To be able to determine parameters that may be used in pricing and valuation of insurance and HMO industries. It aspires to produce the following statistical results: (utilisation rate, length of stay, and average claim amount) by different categories (gender, age group, lP/OP, surgical/non-surgical, ABL/IMBL).
A Morbidity Study System shall be developed to aid in the collection of data and to ensure the integrity of data collected. Companies shall be given access to the system to conduct their own future morbidity study.