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In Australia, I believe private health insurers use a shared-risk model. Basically, they cannot deny anyone insurance based on health/age. Once a year, all in
by lysp 4y ago
In Australia, I believe private health insurers use a shared-risk model.
Basically, they cannot deny anyone insurance based on health/age.
Once a year, all insurers submit their claims data to a central pool. They will then need to pay a certain amount to the pool, or get a refund based on their claims vs the rest of their providers.
That means risk is shared between all companies, and they don't need to deny people plans like in this case on the chance they get too many "bad customers".
- DavidPeiffer 4y agoI believe this is part of how the Obamacare marketplace works. I networked with a team from a major insurance company who exclusively worked with marketplace plans. They all said "I morally wouldn't work here if we were optimizing plans to avoid paying, like happened before Obamacare" and went on to explain a similar setup. In the scheme of things, it's a relatively small part of the overall population, but still very important.