The low claims discount is calculated for each member 42 days prior to the anniversary date. The calculation is based on a comparison of premium against the total amount paid in claims over the previous three years. If the value of the claims paid equates to less than 70% of the premium paid, the member is eligible for the low claims discount, which is automatically applied from the anniversary date.
The premium value is calculated by taking the current year’s premium and multiplying it by three.
The claims value is calculated from anniversary date, not calendar year, and is based on when claims are paid, not when the event took place nor when the claim was submitted. It excludes pre-approvals and the GP health check loyalty benefit.
If a member made a claim in the 42 days prior to their anniversary, this would not be included in the low claims discount calculation until the following year.
The discount applies for 12 months from the policy anniversary.
The low claims discount is only applicable to adult rates on the Major Medical Plan and Real Value Plan. These are legacy Accuro plans and are no longer on sale. Any current or previous members of an Accuro workplace health insurance scheme, or on dependent rates under the above products are not eligible for this discount.
We offer the low claims discount at our discretion. We may change or remove it upon giving notice to policyholders. We will give 21 days notice of any changes to premium.
If Mary’s anniversary is 01/10/2021, we will take the rate for the year 1/10/2020 to 30/09/2021 and multiply it by three. If Mary’s annual premium for last year was $1000, it would be $1000 x 3 = $3000.
Once we have the three-year figure, we calculate the 70% claims threshold. Eg: $3000 x 70% = $2100.
We then look at Mary’s claims from 21/08/2018 to 21/08/2021 (42 days before her anniversary date).
If Mary claimed for less than $2100 in this period, she would be eligible to receive the low claims discount which would be applied from her next anniversary.
If Mary had a hip replacement that cost $20,000, she would have exceeded the low claims threshold and would not be eligible for the low claims discount.