Contemporary Issues in Private Health Insurance. Health Practice Committee: Andrew Gale Ben Ooi

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1 Contemporary Issues in Private Health Insurance Health Practice Committee: Andrew Gale Ben Ooi

2 Outline A new insurer Trends Private Health Insurance Act 2007 Broader Health Cover Appointed Actuary role Risk Equalisation changes Solvency & Capital Adequacy Standards Demutualisations and ASX Listings Health Practice Committee

3 A new insurer First new insurer in 20 years making 38 insurers National Health Benefits Australia Pty Ltd Operates as OneMediFund open and for-profit Managed by Peoplecare from Wollongong Same products Same systems Same management Diversification for Peoplecare

4 Sep-71 Mar-72 Sep-72 Mar-73 Sep-73 Mar-74 Sep-74 Mar-75 Sep-75 Mar-76 Sep-76 Mar-77 Sep-77 Mar-78 Sep-78 Mar-79 Sep-79 Mar-80 Sep-80 Mar-81 Sep-81 Mar-82 Sep-82 Mar-83 Sep-83 Mar-84 Sep-84 Mar-85 Sep-85 Mar-86 Sep-86 Mar-87 Sep-87 Mar-88 Sep-88 Mar-89 Sep-89 Mar-90 Sep-90 Mar-91 Sep-91 Mar-92 Sep-92 Mar-93 Sep-93 Mar-94 Sep-94 Mar-95 Sep-95 Mar-96 Sep-96 Mar-97 Sep-97 Mar-98 Sep-98 Mar-99 Sep-99 Mar-00 Sep-00 Mar-01 Sep-01 Mar-02 Sep-02 Mar-03 Sep-03 Mar-04 Sep-04 Mar-05 Sep-05 Mar-06 Sep-06 Mar-07 Trends Membership 12,000,000 10,000,000 Total Hospital Coverage (number of persons covered) Introduction of Medicare from 1 February 1984 Introduction of Life Time Health Cover from 1 July ,000,000 6,000,000 4,000,000 2,000,000 Commonwealth medical benefits at 30% flat rate restricted to those with at least basic medical cover from September 1981 Medibank began on 1 July A program of universal, non contributory, health insurance it replaced a system of government subsidised voluntary health insurance. Introduction of 30% Rebate from 1 January 1999 A U S T 0

5 Price Increases Trends AVERAGE CONTRIBUTION RATE INCREASES 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% 7.0% 6.8% 6.9% 7.4% 7.6% 8.0% 5.7% 4.9% 4.5% 1.8% 0.0%

6 Ageing Year ended Trends Hospital Insurance Risk Profile change Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % Dec % June %

7 Trends Financial Performance

8 Private Health Insurance Act 2007 Separated from National Health Act 1953 Appointed Actuary role Broader Health Cover Risk Equalisation changes Health Benefits Fund concept (statutory fund) Health insurance business vs health related business Re-registration of health funds required Private health insurance website SIS Health insurance products need to be complying

9 Appointed Actuary Division 160 of Private Health Insurance Act similar to APRA Life Insurance Appointed Actuary regime details in Private Health Insurance (Insurer Obligation) rules Appointed Actuary has qualified privilege whistleblower provisions Specified duties of Appointed Actuary valuation of insurance liabilities and valuation model determination of discretionary margin in Capital Adequacy determination of risk margins for financial statements annual Financial Condition Report

10 Notifiable Circumstances Health funds must advise actuary of: proposed changes to premiums or benefits changes to strategic or business plans development of new products or major changes to products changes to investment policy development of or changes to capital management plan any other event expected to have a significant financial impact Appointed Actuary must provide advice on these matters if warranted

11 Broader Health Cover Hospital Substitute Treatment Chronic Disease Management Programs Actuarial issues Product structure and packaging Benefit design and management Pricing Liability issues Liability Adequacy Test, Outstanding Claims provision

12 Risk Equalisation changes Age based pool Age Old % pooled New % pooled % 0% % 15% % 43% % 60% % 70% % 76% % 78% % 82% % 82% % 82%

13 Risk Equalisation changes High cost claims pool (replaces Chronically ill) Operates within each state (ACT part of NSW) Financed by levy per SEU Single parents: 1 SEU (previously 2 SEUs) 500 SEU minimum removed for state reporting Medical benefit limit of 116% MBS fee removed

14 Review of Capital Standards Solvency & Capital Adequacy Standards developed in 2000 revised in 2003 after initial operating period revised in 2005 for IFRS revised in 2007 for new legislation PHIAC has commenced a review - Initial industry paper: responses by 5 Oct - Preliminary view paper: Oct-Nov Proposed changes paper: Jan-Feb Draft Capital Standards: May-June Implementation of new standards: 1 Jan 2009 PHIAC is establishing a Standards Reference Group

15 Demutualisations and ASX listings

16 Demutualisations and ASX Listings NIB March 2007: announced plans to demutualise 19 July 2007: members vote in favour of demutualisation Late 2007: ASX listing expected MBF 17 August 2007: Council endorse demutualisation proposal 31 August 2007: BUPA announces interest in buying MBF 2008: MBF expects to demutualise and list on ASX Medibank Private December 2006: Medibank Private Sale Act passed 2008: ASX listing expected if coalition government re-elected

17 Health Practice Committee PHI CPD on-line course Submissions on CapAd Standards revision Review of Guidance Notes - GN650 OSC liabilities and provisions - GN660 financial projections - GN670 financial condition reports - new material - appointed actuary role/responsibilities - IFRS

18 Questions & Discussion

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