Once covered, forever covered: The actuarial challenges of the Belgian private health insurance system

Abstract

The Belgian Law of 20 July 2007 has drastically changed the Belgian private health insurance sector by making individual contracts lifelong with the technical basis (i.e. actuarial assumptions) fixed at policy issue. The goal of the Law is to ensure the accessibility to supplementary health coverage in order to protect policyholders from discrimination and exclusion, essentially when these operate on the basis of age. Due to the unpredictable nature of medical inflation risk and the difficulty to model future increases of health claims, the legislator introduced medical indices together with a specific updating mechanism, which aim at establishing standardized and fair premium adjustments across the sector. This paper considers two major issues of the current Belgian system. The first one is related to the transferability of the reserves, whereas the second one is related to age-discrimination. We discuss these issues and their interplay, and we address the conflict between the goal of the Law and the practical problems arising in the light of the actuarial techniques.

Efeitos das Regras de Precificação na Taxa de Cobertura da Saúde Suplementar

“…Dentre tantos desafios presentes no mercado segurador da saúde, este trabalho busca estudar especificamente o problema da seleção adversa (NEUDECK et al, 1996;PARDO, 2019) em uma carteira de planos individuais de uma operadora e uma extrapolação da análise para o mercado de saúde suplementar do Brasil. A abordagem da precificação dos serviços da saúde suplementar converge para o conceito de loss coverage (THOMAS, 2007;HAO et al, 2018;HAO et al, 2019;Hanbali et al, 2019), que será desenvolvido na seção referente à metodologia deste estudo. Embora seja foco deste estudo, a seleção ad-versa e seus determinantes não são o objetivo deste trabalho, mas sim explorar o impacto da estrutura de precificação na taxa de cobertura.…”