Actuaries in health insurance
Private health insurance plays a central role in the healthcare system and is therefore subject to strict regulations. Responsible actuaries must balance actuarial requirements, corporate responsibility, and socio-political guidelines in their work. Legislative changes, medical advances, and shifts in policyholder behavior continuously impact premium structures, necessitating regular adjustments.
A key focus of their work lies in product development. Through market analysis, actuaries gain insights into insurance needs, adjust existing policies, and develop new ones. They are responsible for premium calculation, the determination of policy reserves, and ensuring compliance with legal requirements in business plans.
Actuaries also play a critical role in the year-end closing process. Increasingly, international accounting standards such as US-GAAP and IFRS/IAS must be taken into account. Following the year-end closing, they perform recalculations to ensure appropriate profit-sharing for policyholders. In addition, they manage premium refunds and secure the risk profile of the policies through actuarial safeguards to protect the insured pool.
Health Insurance Committee
The Health Insurance Committee primarily focuses on issues related to private health and long-term care insurance, as well as current topics that involve independent trustees and responsible actuaries. In its professional work, the committee has also supported the association of private health insurers.
The goal is not only to develop professional standards but also to accompany actuaries in their specific activities and provide them with essential guidelines for their work. The committee also addresses actuarial questions in the area of statutory health and long-term care insurance, as well as topics in both national and international contexts.
Due to its socio-political function as an integral part of the structured system, health insurance is subject to very detailed regulations. Consequently, actuaries face significant demands in navigating the tensions between actuarial interests, corporate responsibility, and social and legal obligations.
The importance of considering the constantly changing conditions in the healthcare sector is increasing, particularly regarding:
- Public discussions on the design of social systems,
- Legislative influences on the framework conditions,
- Medical advancements,
- The situation in capital markets, and
- Increased safety requirements.
It is essential to closely monitor developments in statutory health and long-term care insurance or in supply regulations for public service and to respond accordingly. Internal and external legal and economic aspects form a highly intertwined network of relationships, which actuaries must consider to fulfill their legal and corporate responsibilities.
Working Groups of the Committee
To address the diverse topics in the area of health insurance, the committee has established the following active working groups:
The Working Group AUZ Procedures continuously monitors current developments in the capital markets and their impact on the investment strategy of insurers. Particular attention is given to analyzing the effects on the AUZ methodology.
The Solvency II Working Group is working on an extension of the inflation-neutral valuation method (INBV), with the aim of better reflecting company-specific circumstances regarding the expected periods for premium adjustments.
The Working Group on the Determination of Cancellation Tables aims to adapt and revise the DAV guideline 'Determination of Cancellation Tables' from 2017 to the current framework conditions.
The main goal of the Working Group on Actuarial Requirements for Expert Reports in Private Health Insurance is to develop standardized structures for the preparation of expert reports in private health insurance (PHI). This aims to improve the quality and consistency of the reports, thereby better supporting actuaries in legal proceedings.
The Working Group on Qualification is responsible for the independent quality assurance of the specialist knowledge exams created by the relevant examination board of the Education and Examination Committee.
Health Section
The section meetings of DAV and DGVFM for their members provide an opportunity to keep the necessary practical knowledge up to date and facilitate the transfer of scientific foundational work into practice. Additionally, they promote the exchange of experiences and networking on a personal level.
The Health Section engages in the professional exchange of all actuarial topics, opinions, and research findings related to statutory and private health insurance. Key focus areas include product development, research and planning, adequacy of services, sustainability, insurance, pre-financing, and other financing methods.
The meetings of the Health Section take place twice a year during the annual meetings of DAV and DGVFM in late April and the autumn meeting in November. Participation is open to anyone interested and is not limited to members of DAV or DGVFM.
Publications
The Health Insurance Committee of DAV develops professional standards, supports actuaries working in the field of health insurance in their specific activities, and provides them with essential guidelines for their work.
Here you can find the professional principles and result reports of the Health Insurance Committee.
