- 4,096
Do you consider medical underwriting disclosure as creditable claims data?
How Low Can You Go with SF or PSF Plans?
- Thread starter Ann H
- Start date
More credible. Think about this for a moment. Claims data, not matter how good the reporting is, is always old and very unreliable. Now this varies by vendor, but data is usually 90 days or older. And unless the group is large (300+ or so) the data has a minimal crediblity factor, meaning it is useless or close to useless.
Indvidiual underwriting forms asks each employee/dependent to report up to date information on; diseases, rx, hospital stays, diagnosis, age/sex/, height, weight, and other medical information. How much more credible can you get?
- Thread starter
- #13
From the health questionnaires I've seen, not very credible. It's amazing how much the applicant "forgets", or refuses to disclose, especially if he/she feels that the employer will know about their medical history and Rx usage. I suppose a mixture of health questionnaires and claims data would be the most valuable.
- 4,096
In every truly self funded case I have been involved in the actuaries were dam near 100% accurate on projected claims.
These cases had all the claims data available.
I have 50-99 life case where we have shock claims that happen every year. I had a Blood disorder that was over $300k last year. Not to mention cancers, NicU child births, and so on. I just don't see how you can self fund a group of 25 with low enough specs. and aggs. to make it worth it. Vs fully insured.
To go SF you need to have at least the agg. savings vs FI.
So lets say the agg. is $50K on small group SF. We need to save at least that vs FI to make the risk worth it.
If you do have a super healthy young group, no way you beat the preferred fully insured rate. So once the underwriting aspect is removed from the equation maybe PSF gain more traction.
These cases had all the claims data available.
I have 50-99 life case where we have shock claims that happen every year. I had a Blood disorder that was over $300k last year. Not to mention cancers, NicU child births, and so on. I just don't see how you can self fund a group of 25 with low enough specs. and aggs. to make it worth it. Vs fully insured.
To go SF you need to have at least the agg. savings vs FI.
So lets say the agg. is $50K on small group SF. We need to save at least that vs FI to make the risk worth it.
If you do have a super healthy young group, no way you beat the preferred fully insured rate. So once the underwriting aspect is removed from the equation maybe PSF gain more traction.
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