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Hot Topics in International Self-Insurance / ART

800.851.7789www.SIIA.org

• How�many�international benefits�captive�clients�do�you�have?

Pooling�Networks InͲForce�Captives

5

28

6

1

0

15

1

5

Benefits Captives / Multinational PoolingPulse Survey September 2011

60+captives

with benefits

2

• Where�do�you�see�new�product�innovation�and�new�services�being�added�to�the�multinational�pooling�spectrum�of�solutions?

“We see some room for product innovation in the alternative solutions space, in particular for

global underwriting programs.”

“Some pools will be established for information purposes only and clients

will be willing to pay a fee for this information monitoring service.”

“Increasing demand towards utilization and trends reports on the

health business.”

“Global service standards – real time access.”

“More on-line services and reporting through web based client lock-boxes.”

“Corporate wellness solutions with group medical insurance are actively promoted.”

Benefits Captives / Multinational PoolingPulse Survey September 2011

Aging

Low birth rate

War for talent

Health cost is increasing

Stress and engagement

problems

Social media and

technologies

4 Generations

Diabetes epidemic

CardiovasculardiseasePeople getting sicker

but living longer

Growth and profitability, especially in emerging

markets

Corporate social responsibility

Lifestyle/risk

factors

Governance, litigationand risk management

Global Business and Health IssuesThe World at a Glance

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Why Focus on BRICS?20 years Forecast Growth Rates

Source: Goldman Sachs, 2010

� Attention-grabbing opportunities

� Competition is stiff

� Premium growth faster than GDP

� Penetration implies the market is still immature

� Health issues vary by country

BRICS Market Attributes% Share of World GDP

101.1%2%3%4%Italy7

55.3%3%3%3%Russia9

38.4%6%4%3%India10

75.5%4%4%3%Brazil8

81.9%3%3%4%UK6

91.7%3%4%5%France5

61.0%3%4%6%Germany4

41.0%4%6%8%Japan3

19.0%23%17%9%China2

22.3%17%20%24%USA1

2030 Rank

20-YearCAGR

203020202010Country

2010 Rank

% Share of World GDP

101.1%2%3%4%Italy7

55.3%3%3%3%Russia9

38.4%6%4%3%India10

75.5%4%4%3%Brazil8

81.9%3%3%4%UK6

91.7%3%4%5%France5

61.0%3%4%6%Germany4

41.0%4%6%8%Japan3

19.0%23%17%9%China2

22.3%17%20%24%USA1

2030 Rank

20-YearCAGR

203020202010Country

2010 Rank

Heath Care Inflation in BRICSE7 versus G7 Countries

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Required to Leapfrog Market

PracticeActions to Meet Market Practice

Mature Market NormsCurrent State

Organization ABC

• Fully Insured or Self Insured

• Deductibles

• Co-Pays

• Claims Paid as Reimbursements

• Stand Alone In-House Medical Clinics

• Coordinated Care

• Plan Design Incentives

• Preferred Provider Networks

• Benchmarking

• Employee Communications

• Behavioral Change

• Focus on Chronic Conditions

• Improve Access to Care

• Wellness

• Employee Health Management

• EAPs

• Integrated Medical Clinics

• Data Analytics

• Captives

E7 Countries and BRICSEmerging Markets: Paradigm Shift on Healthcare?

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Balancing Local Differences with Global Similarities

• Culture• Health�risks• Demographics• Employee�needs���������������and�expectations

• Level�of�health�spend• Language

• Basic�biology• Rise�of�chronic�disease• Approaches�to�create�a�culture�of�

health• Need�for�targeted�interventions• Need�for�social�and�personal�

motivators

Local differences

Global similarities

“Global Lite, Local Deep”

• Sources�of�program�ROI• Employer�vs.�����government�role

• Vendor�marketplace

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