You are Renata Obando-Leclerc, director of individual and family business at Costaria Mutual, a mid-sized health insurer. Your individual line is losing members and money. On Friday the Pricing Committee you chair must post next year's premium: one price for anyone who applies.
The situation
It is Wednesday, April 15, 2026. The Chief Actuary's memo opens with a blunt line: individual enrollment is collapsing. In one year the line has lost 18% of its members while average claims per member rose 22%. The 14% premium increase filed for 2025 did not close the gap, and the loss ratio (claims paid over premiums collected) has run above 100% since January, against a target of 86%.
The page the committee read twice was the lapse analysis. Members who left had averaged €1,420 of claims in their final year; those who remain now average €4,180. Under the Superintendency's rules, every applicant in the capital region pays the same posted premium. Each knows far more than the insurer about their own likely medical bills, and the insurer may not price on it.
The actuarial office has built a lab of 1,000 prospective customers, calibrated to the line's claims history: a median expected annual cost of about €1,800, an average of about €3,200, and a few above €40,000. The posted premium stands at €3,200. The chief financial officer, Gloria Mairena-Stout, wants a further 18%: "We are a year behind, not wrong." Esteban Lizano-Marsh, head of member services, wants the price held and the losses absorbed for now. The Chief Actuary, Tomás Ibarra-Fennell, has written that another increase would speed the losses up, and proposes redesigning the line with the regulator.