As part of our ongoing commitment to satisfying the needs and requests coming from the market, Generali Employee Benefits is pleased to have developed a new dashboard report for clients with medical benefits administered by our global Network. The first production of our new Paid Claim Report – Medical was released at the end of September, 2012.
The challenges to producing uniform comparative reports for medical products in multiple countries are many, from the inherent differences in product design, the definition of policies / riders, the diagnostic and procedure coding to IT system capabilities and even adjudication rules. To ensure that the data is as reliable as possible, we are carefully reviewing available data on a country by country basis before including them in our reports. As such, the number of countries included in our first report was somewhat limited but we are committed to steadily expanding this list with some additional countries already targeted to be included in our second production cycle.
The Paid Claim Report – Medical presents a country by country summary of all Paid Claims associated with the covered populations in question and the quarters indicated. The data in the reports are sorted in two ways, first by Benefit Class and then by Diagnostic Category. Some additional data is also provided, but the sorting in these two ways is the primary deliverable.
As the name suggests, these are paid amounts, irrespective of incurred date, meaning that there is no consideration / estimation for necessary Claim Reserves and there is surely a mixing of claims from more than one benefit period. The reports do not reveal the underwriting experience of a population, even though the summarized results can offer insight into where important cost drivers lie.
We are already working on a more detailed Incurred Claim Report expected to be produced on an annual basis, after a six-month run-off in order to approach completion of payment of all incurred claims. The Incurred Claim Report will be structured similarly to the Paid Claim Report, but it will be much more functional for statistically-based conclusions as it will also provide category by category insight into Incidence / Utilization, Average Claim Costs and Total Incurred Claim Costs per Member Year (PMPY). From this report, GEB clients will be able to more easily notice principal cost drivers and year-over-year trends.
Both sets of reports will be available to Clients for a fee. Please contact your Area Manager for further details.