Page 191 - Ebook health insurance IC27

Sashi Publications

(f) Claims Analysis - This analysis show the amount of claim, the total amount
paid, and the amount paid for different benefits, including room nursing, surgery,
miscellaneous etc. This analysis can show total amount of claims paid and the
corresponding number of claims for different years and the components of claim
costs.

Claims analysis can be done on the basis of
(i) Sum Insured - This shows the distribution of number of claims paid, the

corresponding claim amount paid for each sum insured range, the percentage
of total claim amount paid for each sum insured range. This analysis helps to
point out the utilization level at different sum insured ranges.
(ii) Age Bands - This shows the distribution of claims and the number of people
claiming by age bands, the number of claims and amounts paid for each age
band and the percentage total amount paid for the respective age bands.
This analysis helps in identifying the frequency and severity of claims from
different age bands.
(iii) Geographical Locations - Claim frequency and severity can be calculated
separately for each geographic region. In addition, analysis on the basis of
ICD codes can indicate the likelihood of claim for particular disease/ higher
healthcare costs in a locality. This helps in loading premiums of those regions
and revising its sales and marketing strategy.
(iv) Hospitals -This provides comparative analysis among hospitals on the basis
of ICD diagnosis codes. This would help insurers find the high cost hospitals
and renegotiate their tie ups.

(g) Payment Duration Analysis - Total number of claims settled by the end of each
month, from the month of claim occurrence, i.e, it reflects the percentage number

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