Consultant - Actuarial Costing of SHIS Benefit Package at Palladium Group

Project Overview and Role
Health Policy Plus (HP+) is a USAID-funded five-year $185 million project awarded to Palladium in August 2015. HP+ has a mandate across global, country, and subnational levels to strengthen and advance health policy priorities in HIV, family planning and reproductive health (FP/RH), and maternal health

It aims to improve the enabling environment for equitable and sustainable health services, supplies, and delivery systems through policy development and implementation, with an emphasis on voluntary, rights-based health programs, and by strengthening in-country partners’ capacity to navigate complex environments for effective policy design, implementation, and financing aligned to their priorities.

HP+ provides technical assistance to governments, civil society, and the private sector to effectively engage in domestic resource mobilization (DRM), put in place sustainable financing and accountability mechanisms, and make progress toward global, national, and subnational health goals.

Background

• The Ebonyi state Government has signed into law, a bill that establishes the Ebonyi State Health Insurance Scheme with the overall goal of ensuring all residents of the state have access to quality and affordable health care services with financial and social risk protection
• Similarly, the FCT government has set up an agency and developed a benefit package that will ensure a basic package of health care to its residents through the FCT Health Insurance Scheme
• Furthermore, both states have established structures and staffing for the State Health Insurance Agencies (SHIA).

Responsibilities   
Rationale:

• To aid the implementation of the schemes, there is need to cost the benefit package through a proper scientific method and determine an actuarially fair premium that enrollees will be required to contribute
• To complete the analysis, the costs of medical services provision and drugs in the state, the expected administration expenses from operating the scheme, and the cost of payment to providers based on expected utilization need to be understood
• This actuarial analysis will provide an evidence base to ensure sustainable financing of the scheme, using state specific evidence.

Objective:

• The overall aim of this consultancy is to conduct a costing of the FCT and Ebonyi state SHIS benefit packages and determine an actuarially fair premium rate, which factors in the appropriate distribution of medical claims costs, administrative and operational costs, and reserve margin
• The activity will also determine the appropriate allocation for provider payments  (capitation and fee for service)
• This activity will inform the selection of a financially sustainable premium and design elements for the SHIS.

Specific Activities:

• Develop/Adapt a model for the actuarial costing using scientifically accepted methods. 
• Determine the actuarial cost of proposed scenario(s) of the Ebonyi and FCT benefit packages
• Determine the appropriate premium for household and individual enrolment on the SHISs.
• Determine the appropriate distribution of the approved premium revenue towards medical costs, administrative fees, and the reserve margin.
• Determine the medical claim costs split to be allocated for capitation and FFS as appropriate for the SHIS.
• Advise on the administration fee to Third Party Administrators (TPAs) as well administrative and operations expenses to agency.
• Advise on the application of risk mitigation mechanisms and provide the impact of such interventions on medical cost.

Deliverables:

• An unlocked actuarial analysis model that meets best standards
• A worksheet that clearly shows all inputs/calculations/assumptions that are included in the analysis
• All raw data used for the study with sources cited.
• A comprehensive actuarial study report for the FCT and Ebonyi benefit package scenarios containing:
  • A clear methodology used for the actuarial analysis
  • An appropriate premium rate (Individual and Household package) to cover medical costs, overhead, administrative costs, and reserve margin target of the scheme.
  • Modular pricing for the benefit packages based on different scenarios and disease conditions for individual and household packages.
  • Rates for medical payouts (Capitation fee and Fee-for-Service), including tariff structure for procedures, consultations, pharmaceuticals, and diagnostics.
  • Rates for administration fee to TPAs/SHIS/ICT, reserve funds, re-insurance costs, and other anticipated operational and enrolment costs.
  • Sensitivity analysis to determine key drivers of variations in cost to the scheme

Requirements
The Consultant should be a licensed actuary and possess the following:

• An Advanced Degree in Mathematics, Statistics, Finance, Insurance and Actuarial Science or other quantitative fields with at least 7 years of experience in this field.
• Strong statistical, analytical, and monitoring skills with a solid understanding of all life/disability actuarial techniques, standards, and assumptions
• Strong knowledge of insurance operations and the procedures of Financial, Underwriting, Claims, Statistical, Information Technology, Legal, and Sales departments
• Experience in conducting actuarial analyses for health insurance in Nigeria.
• Must have experience leading rate-making and pricing initiatives for insurance products.
• Effective written and verbal communication skills in presenting recommendations to non-actuaries.
• Advanced computing knowledge and high proficiency in use of spreadsheet applications.
• Membership of Chartered Insurance Institute of Nigeria will be an added advantage.

Expected Period of Performance of the Consultant:

• May 8th to June 25th, 2019. (40 days: 20 days per state)

Working with and Reporting to:

• The Consultant is expected to work closely with technical specialists from FCT and Ebonyi and support federal and HQ HP+ team to ensure optimum standards
• The consultant reports to the HP+ technical monitor.