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HEALTH CARE PLANS - ACTUARIAL ASPECTS

It is of significant importance to a Health Care Plan with characteristic self-sustainability studies and technical and actuarial analysis. With their results, to be performed by appropriately qualified actuary, management can make decisions that balance financial and actuarial, compliance with applicable law and associate satisfaction.

In summary, the work to be performed by the actuary are:

1) to allow initial actuarial study the feasibility of implementing the plan with the definitions of alternative funding, the list of benefits and biometric characteristics of the estimated population of beneficiaries;

2) Development of Actuarial Technical Note for registration of the product with its annexes, as required by the National Supplementary Health Agency - ANS;

3) monthly monitoring of the evolution of all technical aspects of the Plan, through studies and analyzes technical and actuarial submission to the Board with the Plan of outcomes related to:

· Income from fees;
· Co-participation revenues;
· Income from investments;
· Costs of benefits provided for in Regulation;
· Management expenses;
· Overheads and others;
· Loss ratios, by type of service, such as visits, outpatient, diagnostic, treatment, hospitalization, etc..

4) Annual Actuarial Valuation containing statistical studies, financial and actuarial;

5) Preparation of Technical Note Provisions containing the values ​​of equity and the Minimum Technical Provisions as legislation, with the presentation of appropriate methodologies and algorithms;

6) Issuance of Opinions containing actuarial analysis and suggestions to the Board's plan to impose the necessity of making decisions for the implementation and maintenance of financial and actuarial balance;

7) Participation in regular technical meetings with the Management Plan in order to present the results of technical studies and actuarial analyzes for decision making is necessary.

As we see, actuarial work is essential to maintaining the capacity of the Plan, or Operator, to take on commitments under Regulation.

Porto Alegre, July 22, 2011.

Prof. Roseni Goldsmith
Actuary-MIBA 760.
Director of SEA-servs. Statistics and Actuarial Science Ltda.