Page 193 - Ebook health insurance IC27

Sashi Publications

Q6. Write a note on IBNR analysis.
Ans. These are the claims incurred, but not repeated by the end of the accounting

period. There are four types of analysis that can be done on the data for IBNR
analysis. The first and second analysis show the development of incremental
payments by the month of payment and the development of cumulative payments
for each month.

The third analysis will show percentage completion of payments, based on selected
factors, by the end of corresponding number of months for each claim occurrence.
The fourth analysis show the completion factors for different methods and the
selected completion factors.

This IBNR analysis help an insurerestimate its reserves appropriatelyand to estimate
the full incurred claims for any time period under study. It is used in rating and
trend analysis and every other special ad hoc analysis of claims expense undertaken
by the insurer, and assists the insurer in filing the annual liability report with the
Regulator.

Q7. Explain the concept of ICD-10 coding system. For what purpose it can be
analyzed?

Ans. The International Statistical Classification of Diseases and Related Health Problems
(ICD) , provides codes to classify diseases and a wide variety of signs, symptoms,
abnormal findings, complaints, social circumstances and external causes of injury
or disease. Every health condition can be assigned to a unique category and given
a code, upto six characters long. Such categories can include a set of similar
diseases. The ICD is published by WHO.

It is used worldwide for morbidity and mortality statistics, reimbursement systems

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