Saad B.
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Claim analysis 2023/2024 policy year
Analysis
Average utilization per month is aproximately SAR 200K
Employees are showing the top utilizing among the population which is normal and within the market trend
Monthly claims
300
200
100
0
Jan
Feb
Mar
Apr
May
Jun
Employee
Spouse
Child
Utilization per member type
Member type
Employee
Spouse
Children
Total paid claims
No of claims
619
330
370
1,400
Claim value (SAR)
364,000
234,000
134,000
800,000
% of total claims
50%
30%
20%
100%
Claim analysis per treatment type
Analysis
Out-Patient utilization is within the market norm. The market norm varies between 70%-80% for out-patient.
In-patient utilization is above the market norm. The market norm varies between 18%-20% for in-patient.
Optical utilization is higher than market standard. The average market range is between 1%-3% for optical.
Treatment type
SAR 300K
SAR 100K
SAR 100K
SAR 50K
0
IP
OP
Pharmacy
Dental
Optical
Not classified
Employee
Spouse
Child
Claims analysis 2023 / 2024 policy year
Member
Employee
Spouse
Children
Total
%
IP (SAR)
36,000
90,000
10,000
140,000
%20
OP (SAR)
140,000
100,000
50,000
340,000
%40
Pharmacy (SAR)
140,000
100,000
50,000
340,000
%20
Dental (SAR)
14,000
10,000
5,000
34,000
%4
Optical (SAR)
14,000
10,000
5,000
34,000
%4
Not classified (SAR)
1,000
1,000
500
3,000
%1
Top 10 utilized diognosis by SAR value
Claims analysis 2023 / 2024 policy year
Treatment diagnosis
Pregnancy
Disease of nervous system and sense organs
Disease of respitory system
Disease of musculoskeletal system
Dental/oral diseases
Disease of genitourinary system
Symptoms, signs and ill-defined conditions
Injury and poisoning
IP (SAR)
36,000
90,000
10,000
140,000
140,000
140,000
140,000
40,000
OP (SAR)
140,000
100,000
50,000
340,000
340,000
340,000
340,000
50,000
Pharmacy (SAR)
140,000
100,000
50,000
340,000
50,000
50,000
50,000
50,000
Dental (SAR)
14,000
10,000
5,000
34,000
50,000
50,000
50,000
50,000
Optical (SAR)
14,000
10,000
5,000
34,000
50,000
50,000
50,000
50,000
Not classified (SAR)
1,000
1,000
500
3,000
3,000
3,000
3,000
3,000
Top 10 Utilized Providers by SAR Value
Analysis
Top visited providers are all hospitals regardless of the treatment type. (Out-patient - or In-patient) 53% of Out-patient utilization were done in hospitals only.
Visited hospitals
35%
30%
15%
20%
Saudi German Hospital
Riyadh
Riyadh
Al Falah Hospital
Riyadh
Riyadh
Dallah Hospitals - Alnakheel
Riyadh
Riyadh
King Faisal Specialist Hospital
Riyadh
Riyadh
VIEW ALL
Top 4 utilized providers by SAR value
Hopital
Saudi German Hospital
Al Falah Hospital
Dallah Hospitals - Alnakheel
King Faisal Specialist Hospital
IP
(SAR)
(SAR)
36,000
90,000
10,000
140,000
OP
(SAR)
(SAR)
140,000
100,000
50,000
340,000
Pharmacy
(SAR)
(SAR)
140,000
100,000
50,000
340,000
Dental
(SAR)
(SAR)
14,000
10,000
5,000
34,000
Not classified
(SAR)
(SAR)
1,000
1,000
500
3,000
Total
(SAR)
(SAR)
14,000
10,000
5,000
34,000
Claim ratio
Analysis
Best case scenario based on 2 months tailing (difference between 9 month projection and full run-off 2023/24)
Worst case scenario based on 2.5 months tailing (martket practice at 9 month for Pernod group size)
Claims analysis loss ratio projections
Description
Policy period
Reporting period
Membership average (lives)
Earned premium
9 months claim value until 29 Feb 24
Projection of claims for 12 months
Incurred but not reported
Total claim projection
Projected loss ratio vs annual earned premium
2023/24 projected claim fun value
Net loss ratio (based on claim fund of premium)
Best case scenario
2 Months tailing
Jun 2023 - Jun 2024
13 Jun 23 to 20 Feb 24
146
SAR 1,800,000
SAR 700,000
SAR 1,400,000
SAR 200,000
SAR 1,600,000
%90
SAR 1,300,000
%120
Worst case scenario
2 Months tailing
Jun 2023 - Jun 2024
13 Jun 23 to 20 Feb 24
146
SAR 1,800,000
SAR 700,000
SAR 1,400,000
SAR 200,000
SAR 1,600,000
%94
SAR 1,300,000
%125
Average
Jun 2023 - Jun 2024
13 Jun 23 to 20 Feb 24
146
SAR 1,800,000
SAR 700,000
SAR 1,400,000
SAR 200,000
SAR 1,600,000
%92
SAR 1,300,000
%122
Claim ratio
|
44%
Higher than industry benchmarks
2024
100
70
35
0
Jan
Feb
Mar
Apr
May
Jun
Jul
74%
23%
Higher than June
Policy
industry benchmarks