Description: This paper develops a formal framework to model the behavior of individual and small group health insurance policies in a competitive market. In this framework, anti-selective lapse is not assumed, but arises as a result of rational consumers seeking the best value in a competitive market where the premium rates are restricted by law. The authors obtain a model that addresses a number of fundamental questions which have not been fully answered previously, including the effect of price-induced anti-selective lapse on the mix of insureds in a block and the optimal renewal price to maximize the aggregate profit of a block.

Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.