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Health and care

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Actuaries and Health Insurance

Because of its socio-political function as an integral part of the multi-payer system of health care, private health insurance is subject to detailed regulations. This makes particular demands of actuaries, and especially Responsible Actuaries, in health insurance since they are forced to reconcile actuarial concerns, entrepreneurial responsibility and their socio-political remit. Influence exerted by legislators, medical advances and changes to the claims behaviour of insured persons have a considerable impact on existing tariff structures and make new tariffs necessary. It is not only necessary to observe market requirements in private health insurance; developments in the field of statutory health insurance or of benefit regulations for the civil service have to be monitored carefully too.

As in other insurance lines actuaries working in health insurance are also called upon to work in the varied field of product development. Using market analyses of the needs of insurance customers, actuaries gain insights into the necessity to adjust existing tariffs and to introduce new ones. Using these insights they then work on the calculation of the premiums and the technical actuarial reserves. Actuaries are accountable for compliance with the product business cases, and thus for the integrity and probity of the company's mathematical bases for calculation, as well as for ensuring that the business cases comply with prevailing legal regulations.

Actuaries are also closely involved in producing the company's annual accounts. Recently, as a result of increasing globalisation, they must comply with both national and, to an increasing extent, with international valuation principles (US-GAAP, IFRS/IAS). After the company's annual financial accounts have been produced, the actuaries have to make a recalculation in order to be able to make an appropriate proposal concerning the level of with-profits bonus participation for the company's policyholders.

In addition, actuaries working in health insurance have to consider the important subject of premium rebates. Moreover, the assumptions used by the actuaries have a significant impact on the risk situation for a given tariff. In particular, actuaries have to provide a solid, reliable mathematical basis for any risk premiums/ loadings that may be required so as to protect the community of policyholders.

DAV’s Health Insurance Committee

The DAV's Health Insurance Committee develops professional standards, supports the specific activities of actuaries working in health insurance and provides them with relevant guidance and guidelines for their work.

Professional Standards of Practice

The following list provides an overview over the professional standards published by DAV's Health Insurance Committee. For every professional standard there is an abstract in English and the full version in German available.

expand Category : advisory note ‎(10)
expand Category : guideline ‎(3)

 Content Editor ‭[4]‬

HEALTH Section

The HEALTH Section concerns itself with the exchange of specialist knowledge on all actuarial topics, opinions and research findings in the field of statutory and private health insurance. Its particular focuses include product development, research and planning, the appropriateness of services, sustainability, insurance, pre-financing and other methods of funding.

The HEALTH Section meetings take place twice a year during the Annual Meeting of the DAV and DGVFM at the end of April and the Autumn Meeting in November. Participation in the meetings is open to any interested party and not restricted to members of the DAV or the DGVFM.

 Content Editor ‭[1]‬


If you have any questions regarding health insurance please contact:

Sinem Sarma-Guenes
0221/912 554-226

 Content Editor ‭[3]‬


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