We answer some frequently asked questions that our clients usually ask us about our services.
An Actuary is a professional specialized in applying mathematical and statistical principles to analyze financial risks and assess the long-term financial implications of decisions. Actuaries leverage their skills in mathematics, statistics, economics, and finance to conduct precise and quantifiable assessments of various situations, especially in the realms of insurance and pensions.
International Accounting Standards (IAS) are a set of accounting standards and principles issued by the International Accounting Standards Board (IASB) that provide a global framework for the preparation and presentation of financial statements. These standards aim to establish a common and understandable set of accounting standards that can be consistently applied worldwide, facilitating the comparability of financial statements across different entities and jurisdictions.
Corporate Health Insurance is a medical insurance plan acquired by an organization to provide healthcare coverage to its shareholders, executives, and employees. This type of insurance is designed to benefit both the company and the insurance beneficiaries, offering a range of medical services and benefits. Providing corporate health insurance is a key strategy for attracting and retaining talent, as executives and employees highly value health benefits. Additionally, it provides financial security to executives and employees and can enhance morale and productivity within the company.
A health insurance ecosystem is an integrated network of interconnected services and stakeholders that collaborate to provide a more comprehensive and efficient experience in healthcare for policyholders. It encompasses far more than the traditional insurance policy, as it includes a range of services working synergistically to promote well-being, improve the quality of medical care, and reduce long-term costs.
Pay-per-use refers to a model where users pay only for the services or products they consume, rather than paying a fixed fee or subscription. This approach is common in industries such as technology, transportation, and insurance, where costs are adjusted based on the customer's actual usage. It is a model that offers greater flexibility and control over expenses, as clients pay solely when they use the service.
A pay-per-use health insurance model is based on policyholders paying only for the healthcare services they actually use, rather than a fixed or monthly premium that covers a wide range of services. In this structure, policyholders have the flexibility to adjust their payments according to their actual use of medical services, such as consultations, exams, or treatments. This model aims to offer a more accessible and personalized option, providing greater control over healthcare costs by eliminating unnecessary expenses for unused services.
Startups are emerging companies that aim to develop a scalable and replicable business model, often with a focus on technological innovation or entering new markets. These companies are typically in their early stages of development and possess high growth potential, but they also face significant risks and considerable uncertainty.
Insurtech and Fintech are terms that combine technology with the insurance and finance sectors, respectively.
Insurtech:
- Definition: The fusion of "insurance" and "technology." It refers to the use of innovative technologies to enhance and transform the insurance industry.
- Purpose: Insurtech aims to optimize how insurance companies operate, from policy underwriting and risk management to claims resolution and customer service. This includes leveraging artificial intelligence, big data, blockchain, and other emerging technologies to provide more efficient and personalized services.
Fintech:
- Definition: The combination of "financial" and "technology." It pertains to the application of technology to improve and automate financial services.
- Purpose: Fintech encompasses a broad range of applications in the financial sector, including digital payments, online lending, automated investments, and personal financial management. Its goal is to make financial services more accessible, faster, and more efficient by utilizing technologies such as blockchain, artificial intelligence, and data analytics.
Both terms represent the intersection of technology with their respective fields, driving innovation and transforming the way we interact with financial and insurance services.
Primary Health Care (PHC) is the first level of care within the healthcare system, focused on providing basic health services in an accessible and equitable manner. Its objective is to prevent, diagnose, and treat common illnesses, as well as to promote health through patient education. PHC serves as the first point of contact for patients within the healthcare system and is designed to provide continuous, personalized, and close care. Additionally, it coordinates access to other levels of care when necessary, ensuring continuity in patient care.
The key elements of Primary Health Care (PHC) include:
- Accessibility: Ensures that all individuals, regardless of their location or socioeconomic status, can access healthcare services equitably.
- Comprehensive Care: Encompasses prevention, diagnosis, treatment, and rehabilitation of illnesses, as well as the promotion of healthy habits.
- Continuity of Care: Provides ongoing care over time, ensuring patients receive consistent and coordinated medical attention, even when referred to specialists.
- Service Coordination: Acts as the central reference point for patients, facilitating integration with other healthcare system levels (hospitals, specialists, etc.).
- Prevention and Health Promotion: Focuses on disease prevention through health education and promoting healthy lifestyles to improve the overall well-being of the population.
- Doctor-Patient Relationship: Encourages a close and trusting relationship between the patient and their doctor or healthcare team, allowing a better understanding of each individual's needs.
- Community Focus: Considers the social determinants of health and promotes community participation in decisions related to their well-being.
These elements are essential to ensuring efficient, personalized healthcare focused on the overall well-being of the population.
Integrating Primary Health Care (PHC) coverage into a health insurance policy involves designing the plan to include access to basic and preventive medical services, enhancing the user experience while reducing long-term costs. Here are several ways to achieve this:
Routine Medical Consultations: Include regular visits to a primary care physician at no extra cost or with low copayments, encouraging policyholders to undergo periodic check-ups.
Prevention and Health Promotion Programs: Incorporate preventive programs such as vaccinations, health screenings, and campaigns promoting healthy habits, all at no cost or with significant discounts.
Chronic Disease Management: Facilitate access to chronic disease management (e.g., diabetes, hypertension) with continuous follow-up through PHC, helping to prevent complications and costly hospitalizations.
Telemedicine and Remote Care: Offer virtual primary care services, allowing for remote medical consultations for minor health issues, reducing the need for in-person visits.
Coordinated Referrals: Ensure that PHC serves as the first point of contact and coordinator for referrals to specialists, avoiding duplication of services and ensuring better continuity of care.
Preventive and Diagnostic Coverage: Include routine medical tests (blood work, early detection screenings) to promote early diagnosis of diseases.
Health Education: Provide access to health education resources, both virtual and in-person, to encourage prevention and self-care.
This approach fosters comprehensive health for policyholders and reduces future costs for insurers by focusing on prevention and early intervention.
Yes, there are startups in the health insurance sector, often referred to as Insurtech (insurance technology). These emerging companies leverage technological innovations to enhance, streamline, and make health insurance more accessible. Some of the most notable startups in this space include:
Oscar Health: A U.S.-based startup offering personalized health insurance plans, using technology to improve user experience by facilitating policy management, claims processing, and medical consultations through mobile apps and digital platforms.
Alan: A French insurtech focused on simplifying health insurance, providing a fully digital, fast, and easy process for obtaining coverage. It also integrates telemedicine services and wellness programs.
Lemonade: Although primarily known for property insurance, Lemonade also offers pet health insurance and is expanding its AI-driven technology towards broader health insurance solutions in the future.
Bind Benefits: This U.S. startup provides an on-demand health insurance model, allowing users to customize their coverage and pay only for the services they need, promoting flexibility and cost savings.
These startups are revolutionizing the health insurance sector by offering more accessible, transparent, and customer-centric solutions through technology.
Bind Benefits operates as an on-demand health insurance provider, offering a unique model that allows users to customize their health coverage. Unlike traditional health insurance, Bind does not require deductibles, making it more transparent and flexible. Users can select and adjust their coverage as needed, paying for specific services they choose, which helps them save on premiums. This flexibility is especially useful for managing unpredictable medical needs while maintaining access to primary care, specialist visits, urgent care, and preventive services.
One of Bind’s standout features is its use of upfront pricing. Members know the cost of services before they receive care, which helps avoid surprise medical bills. Additionally, Bind provides a broad network of providers, enhancing choice and affordability for its users. This approach is designed to simplify the insurance experience and help members make informed decisions about their healthcare.
However, while Bind offers transparency and lower costs, some experts point out that its on-demand nature may leave gaps in coverage, particularly for unexpected emergencies or high-cost treatments. Therefore, it's important for users to thoroughly understand the scope of the services they choose to cover under Bind's model.
Bind’s innovative use of machine learning also helps reduce healthcare costs by streamlining treatments for certain procedures, further driving down expenses for users and employers alike.
Bind has recently rebranded as "Surest" under UnitedHealthcare, continuing to offer this flexible insurance model with growing adoption among employers in the U.S.(FirstQuote Health)(Welcome to UnitedHealth Group).