PENGGUNAAN METODE BORNHUETTER-FERGUSON UNTUK ESTIMASI CADANGAN KLAIM

Abstract

Health insurance company have to determine claim reserve that’s suitable with the existing condition. There is three party that’s involved in the health insurance management, namely the policy holder, Admedika as the third party administration, and also the insurance company itself as the (insurer). When the policy holder obtained treatments whose financing is done through a health insurance, then the health insurance company have the obligation to finish the financial matters. Delays in payments from insurance companies to health facilities are caused, among others, by the administrative process. Thus, every claim submitted by the insured party to the insurance company will be settled in stages to the health facilities. The data presented from these conditions form a triangle matrix (run-off triangle) which then becomes the basis for estimating the amount of IBNR claims reserves. The Bornhuetter-Ferguson (BF) method involves the amount of premium that has become income for the company and calculates the Ultimate Claim value in estimating the amount of claim reserves. This method is the result of the development of the previous method, Chain-Ladder (CL), which only relies on historical data on claim payments. Premium calculations need to be involved in health insurance, because the insurance period is short, which is only one year. Insurance companies haven't had time to turn around the money to invest, so payment of claims will depend more on the premium that becomes income for the company (earned premium). The estimated claim reserve value is more suitable and robust than the CL method. Estimated claim reserves that occur in the 2nd event period amount to IDR50,658,714 with an estimated interval for the 2nd event period between IDR10,215,477 and IDR91,101,950