Abstract
Applying supervision in the insurance market includes many areas, and therefore, the methods of intervention and applying supervision in the insurance market have been one of controversial topics among experts. This issue becomes more important in group supplementary health insurance that has a high loss ratio in the insurance industry. Although the Supreme Council of Insurance, in Clause F of Article 10 of Regulation No. 94 of the Supreme Council of Insurance, the special criteria for determining rates of group health insurance has been determined, according to Article 2 of this regulation, insurance companies are required to comply with the technical standards for determining the insurance rate under Article 1, the insurance rate, the tariff table, the amount and cases of discounts and/or additions. The rates of various insurance fields and any changes in them shall be determined by a committee consisting of the internal actuary, the technical officer of the relevant field and the technical deputy, and after the approval of the CEO (or his deputy), shall be approved by the board of directors, and at the same time as it is communicated, a copy along with the explanatory report of the calculation basics shall be issued to Central Insurance of Iran. Therefore, Central Insurance of I. R. Iran as the supervisory body of the insurance industry, it has not interfered in determining the rates and only a copy of the basis of calculation of the rates is sent to it. In this regard, the current research project aims to investigate the interference/non-interference of the supervisory body in determining the group health insurance premium rate, the specific criteria for determining the group health insurance premium rate, and how to manage the risk of this pricing and supervision of the supervisory body in terms of these parameters. Examine the selected countries (India, United States, Switzerland, Türkiye, Australia) and then, based on the results, provide suggestions for amending the 94th regulation of the Supreme Insurance Council in the group health insurance sector.
Keywords: Group Health Insurance, loss ratio, actuary, regulatory body