what's a claim ratio and how does it determine medical renewals? скачать в хорошем качестве

what's a claim ratio and how does it determine medical renewals?

Most organizations only begin to ask critical questions about their medical insurance… When the renewal premium goes up. Last week, I had a very fruitful engagement with an Executive who reached out to understand why their organization was being asked to increase their medical insurance premium at renewal. Last year, they paid: KES 15,000,000 This year, their renewal came in at: KES 17,500,000 A KES 2.5M increase — despite no significant change in staff numbers. Naturally, the question was: “What has changed?” After our engagement, the answer lay in one key metric that is often misunderstood: 📊 The Claim Ratio Claim Ratio measures how much of the premium paid has been utilized in settling medical claims within the policy period. In simple terms: If an organization pays: KES 15M in premiums and Utilizes KES 12M in treatment Then the Claim Ratio becomes: 80% Once the claim ratio begins to trend towards: 75% 80% 90%+ The scheme moves from: Sustainable → Risky → Unsustainable And this directly influences: Renewal terms Benefit restructuring Premium adjustments Out of this meeting, I decided to do the short video below to help other HR Leaders better understand: What Claim Ratio is How it determines medical scheme renewals And the practical strategies that can be put in place to diagnose and monitor claim ratio performance These may include: Introducing co-pay Aligning outpatient access to mid-tier hospitals Wellness and disease management programs Dependent utilization audits Hospital tier restructuring where high healthcare costs are the main drivers There are, of course, many other factors that affect claim ratio — and several proactive strategies that can be implemented early enough to ensure scheme sustainability. One of them is working with a reliable and trusted insurance advisory partner to help monitor utilization trends and recommend timely interventions before renewal negotiations. 🎥 In the video below, I break this down further. #HRLeadership #EmployeeBenefits #MedicalInsurance #RiskManagement #ClaimsRatio #InsuranceAdvisory #InsuringJoy