IC sets guidelines for accreditation of HMO actuaries

THE INSURANCE Commission (IC) has formally rolled out regulatory guidelines on accrediting actuaries of health maintenance organizations (HMOs).

Under the new regulations, accredited actuaries of HMOs in the country are now required to be a fellow in good standing of the Actuarial Society of the Philippines ( ASP), a similar requirement for actuaries of life, non-life and pre-need companies under the Insurance Code and Pre-Need Code.

The ASP is a recognized professional membership organization for actuaries in the Philippines.

“HMOs assume morbidity risks with the collection of fees in exchange for services. For that reason, HMO should have an actuary — a professional who uses mathematics, statistics and financial theory to analyze the financial consequences of risk — to ensure the financial capabilities of HMOs to render services as stipulated in their agreement with their members,” Insurance Commissioner Dennis B. Funa was quoted as saying in a statement e-mailed to reporters on Thursday.

Accredited actuaries will have official access to sign actuarial certifications that will be submitted by an HMO in pursuant to the insurance regulator’s rules. The individual is required to perform the duties and responsibilities as an HMO actuary.

“Under our rules of reportorial requirements of HMOs, they are required to submit morbidity studies, claims experience, expense study and valuation report which must be prepared by an IC-accredited actuary. These actuarial reports are important in determining the amount of reserves of a company to meet their future obligations to its members,” Mr. Funa said.

According to the IC, an associate in good standing of the ASP may only be accredited as a HMO actuary until Dec. 31, 2018.

The actuary may only continue his duties and responsibilities after the said date on the condition that he has already accomplished all requirements in becoming a fellow of the ASP.

Accredited actuaries are mandated to achieve the minimum required training or seminar and/or examinations conducted by the ASP and endorsed by the regulator from a certain period or they should have at least two years of working experience in actuarial field in the local HMO or medical insurance industry.

The new regulations also strictly prohibit an accredited HMO actuary to be a stockholder, a member of the board of directors, or to have a position in the HMO that may have any conflict of interest as an actuary.

An HMO is a prepaid health care service provider offering comprehensive coverage to its members through partnerships with hospitals and other health professionals.

It operates on the idea of risk-sharing, with the objective of minimizing a member’s financial burden of by covering the costs of medical services availed from partners through the HMO’s common fund.