DEDICATION

To my father, my adviser and infallible support

And

In honor of my mother, for her prayers

I
 ACKNOWLEDGEMENTS
We wouldn’t be able to begin this dissertation without however expressing our gratitude to the
people who took part in a considerable way in the elaboration of this dissertation.

Our thanks go to the people who have been of fundamental support to us during this internship
period.

As such, we extend our sincere thanks and deep gratitude to:

- Mr. Moussa Abdoul Kader DIABY, Managing Director of the National Polytechnic Institute
Félix Houphouët-Boigny of Yamoussoukro (INP-HB);

- Mr. Losseyni BAKAYOKO, Director of the Higher School of Business and Enterprise
Administration (ESCAE);

- Mr. Jean IRIE, research professor at INP-HB, our educational supervisor, for all his efforts;

- All the teaching and administrative staff of the INP-HB;

- Mr. Tiornan COULIBALY, Managing Director of LEADWAY VIE for the welcome and his
advice;

- Mr. Kingsley MILLER, Chief Technical Officer the at LEADWAY VIE, our line manager,
for his guidance and all the confidence granted;

- Mr. Soualou COULIBALY, Life Actuary at LEADWAY VIE, our internship tutor, for the
supervision and the time made available to us;

- Mr and Mrs EBELE ADIOYE for all the support during all these years at INP-HB;

- My wife, Marthe NENE, for her encouragement throughout the writing of this thesis;

Finally, we would like to thank all the people who, from near or far, have given us their support
in any way whatsoever and who could not be named.

II
 FOREWORD
A major pillar of the development of any nation, the youth population has always been at the
heart of the concerns of our African countries. Knowing that it was necessary to invest in the
education and training of its populations to ensure better economic, cultural and social
development, our leaders considered it essential to create infrastructures of excellence in the
field of education and training.

Côte d'Ivoire, not wanting to remain on the sidelines of this trend, has equipped itself with
several didactic infrastructures for the training of our future top leaders, in this case:

- the National Higher School of Agronomy (ENSA); - the National Higher School of Civil
Engineering (ENSTP); - the Agricultural Institute of Bouaké (IAB); - the National Higher
Institute of Technical Education (INSET).

For several years, these various academic structures have enabled Côte d'Ivoire to brilliantly
train competent executives. In 1996, the Ivorian State decided to centralize these training skills
mentioned above in order to create a center of excellence. Thus, on September 4, 1996, the
Ivorian State decided, by decree 96-678, to merge these Grandes Ecoles to create this center of
excellence called the National Polytechnic Institute Félix Houphouët Boigny (INP-HB) of
Yamoussoukro.

The INP-HB today includes: - the School of Continuing Education and Professional
Development (EFCPC);- the Higher School of Agronomy (ESA);- the Higher School of
Business and Enterprise Administration (ESCAE); - the Higher School of Industry (ESI);- the
Higher School of Mines and Geology (ESMG);- the Higher School of Civil Engineering
(ESTP).

To these schools are added the Preparatory Classes for the Grandes Ecoles (CPGE), the
Polytechnic Doctoral School (EDP), Data Science Institute Big Data, the Regional Center for
Higher Education in Metrology, the Aeronautical Training Center and the Higher School of
Petroleum and Energy (ESPE).

These different Grandes Ecoles are responsible for training students in the fields of
administration, business, management, mining, industry, agronomy, civil engineering and
energy.
III
As for our school, namely the School of Business and Enterprise Administration (ESCAE), it
trains senior technicians (Bac +3/DTS) and Master graduates (Bac +5).

The school has within it:

- two (2) streams for the Higher Technician Diplomas: Finance-Accounting (FC) and Business
and Enterprise Administration (CAE);

- four (4) courses of Masters: Higher School of Commerce and Business (ESCA); Higher
Accounting Studies (ECS); Engineers in Logistics and Transport (ILT), Advanced Studies in
Insurance (HEA).

The training of Engineers in Advanced Studies in Insurance (HEA) is the one we followed. To
obtain the diploma, all students must complete their training at the end of their cycle with an
interniship in a company in order to combine the theoretical knowledge acquired with the
realities of the latter.

Thus, the student is required to complete an internship of at least four (4) months sanctioned
by a thesis which is presented before a jury composed of competent teachers. With this in mind,
we have been welcomed for a six (06) month internship since August 17, 2020 at LEADWAY
VIE, a life insurance company.

LEADWAY VIE is a public limited company with a capital of 8,500,000,000 CFA Francs. It
is a subsidiary of the Nigerian LEADWAY Group headquartered in Lagos. Its head office is
located in Abidjan-Plateau, Boulevard Botreau Roussel, Immeuble SUNU 6th floor.

It is managed by Mr. Tiornan COULIBALY, its Managing Director since entering the Ivorian
market in 2018. We were therefore asked to reflect on the subject: “Design of an additional
health coverage product for a pension scheme with deferred capital funding”.

IV
 SUMMARY

DEDICATION ....................................................................................................................... I
ACKNOWLEDGEMENTS ...................................................................................................... II
FOREWORD ...................................................................................................................... III
SUMMARY......................................................................................................................... V
LISTS OF TABLES ............................................................................................................... VI
LIST OF FIGURES ............................................................................................................... VI
LISTS OF DIAGRAMS ........................................................................................................ VII
LISTS OF PHOTOS ............................................................................................................. VII
ACRONYMS AND ABBREVIATIONS .................................................................................. VIII
ABSTRACT......................................................................................................................... IX
INTRODUCTION ................................................................................................................. 1
FIRST PART: THEORETICAL CONTRIBUTIONS ...................................................................... 5
Chapter 1: Presentation of the health coverage system ............................................................. 6
Section 1: General information on health coverage .................................................................................... 6
Section 2: Health Insurance in Côte d'Ivoire ................................................................................................ 8
Chapter 2: Principle of the deferred financing health insurance product ...................................14
Section 1: Presentation of life annuity products ........................................................................................ 14
Section 2: Similarities and Differences with Deferred Funding Health Coverage Product ......................... 23
PART TWO: IMPLEMENTATION OF THE PRICING MODEL .................................................. 28
Chapter 3: Presentation of the stakeholders of the deferred financing health product. .............29
Section 1: Presentation of the different actors .......................................................................................... 29
Section 2: Presentation of Life Insurance on the Ivorian market ............................................................... 47
Chapter 4: Pricing Model for Deferred Health Coverage for Retirees .........................................61
Section 1: Building the model .................................................................................................................... 61
Section 2: Presentation of the results ........................................................................................................ 87
CONCLUSION ................................................................................................................... 89
BIBLIOGRAPHY ................................................................................................................. XI
WEBOGRAPHY ................................................................................................................. XII
TABLE OF CONTENTS ...................................................................................................... XIII

V
 LISTS OF TABLES
Table 1: Comparison of Additional Health Coverage ............................................................. 13
Table 2: Summary of the characteristics of complementary health products .......................... 27
Table 3: Awards of Excellence received by Leadway ............................................................. 31
Table 4: Turnover of the Life Insurance branch in 2020 and 2021 ......................................... 32
Table 5: Category of the services of the product "KANAKASSI" .......................................... 40
Table 6: Life insurance and other categories of insurance ...................................................... 53
Table 7: CIMA F mortality table ............................................................................................. 77
Table 8: Table of benefits for the health product for retirees .................................................. 78
Table 9: Rate of increase in claims by medical procedures ..................................................... 82
Table 10: Application of the growth rates to the pure premium .............................................. 82
Table11: Determination of the Net Premium........................................................................... 83
Table12: Determination of the Present Value of the total contributions ................................. 85
Table13:Determination of periodic contributions .................................................................... 86
Table14: Summary of contributions by age group .................................................................. 87

LIST OF FIGURES
Figure 1: Graphical representation of the claims cost rates for specialized procedures according
to the age of the beneficiaries .................................................................................................. 71
Figure 2: Graphical representation of the claims expense ratios of the analyzes according to the
age of the beneficiaries ............................................................................................................ 72
Figure 3: Graphical representation of dental care claims rates according to the age of the
beneficiaries ............................................................................................................................. 72
Figure 4: Graphical representation of claims rates for medical consultations according to the
age of the beneficiaries ............................................................................................................ 73
Figure 5: Graphical representation of hospitalization claims rates according to the age of the
beneficiaries ............................................................................................................................. 73
Figure 6: Graphical representation of maternity care claim rates according to the age of the
beneficiaries ............................................................................................................................. 74
Figure 7: Graphical representation of pharmacy claims rates according to the age of
beneficiaries ............................................................................................................................. 74

VI
Figure 8: Graphical representation of radiology claims rates according to the age of the
beneficiaries ............................................................................................................................. 75
Figure 9: Graphical representation of the loss ratios of expensive treatments according to the
age of the beneficiaries ............................................................................................................ 75
Figure 10: Graphical representation of miscellaneous care claims rates according to the age of
the beneficiaries ....................................................................................................................... 76
Figure 11: Graphical breakdown of reimbursed claims expense rates by item ....................... 76

LISTS OF DIAGRAMS
Diagram 1: Leadway Vie Organizational Chart………………………………..……….….. 33
Diagram 2: Leadway IARD Organizational Chart………..………………...…………….... 34
Diagram 3: Organization chart of Ankara Services Côte D'Ivoire ………………......…….. 35

LISTS OF PHOTOS

Photo 1: Presentation of the pension plan portfolio ................................................................. 61

Photo 2: Addition of complementary variables to the database .............................................. 63
Photo 3: Presentation of the products of company "A" ........................................................... 64
Photo 4:Presentation of the products of company "B" ............................................................ 65
Photo 5: Presentation of the products of the company "C" ..................................................... 66
Photo 6: Presentation of the products of the company "D" ..................................................... 67
Photo 7: Presentation of the products of the company "E" ...................................................... 68
Photo 8: Presentation of the products of the company "F" ...................................................... 69
Photo 9: Presentation of the products of the company "G" ..................................................... 70
Photo 10: Pricing by comparative analysis between the guarantees of the company "E" and
Leadway ................................................................................................................................... 79

VII
 ACRONYMS AND ABBREVIATIONS

ACRONYMS DEFINITIONS
ASACI Association of Insurance Companies of Côte d'Ivoire
CIMA Inter-African Conference on Insurance Markets
CGRAE General State Employees Pension Fund
CHR Regional Hospital Center
CHU University Hospital Center
CI Côte d’Ivoire
CMU Universal health coverage
CNAM National Health Insurance Fund
CNPS National Social Insurance Fund
CRCA Regional Insurance Control Commission
ALM Asset-Liability Management
IARD Fire, Accidents and Miscellaneous Risks
INHP National Institute of Public Hygiene
INSP National Institute of Public Health
IPS Social Welfare Institution
PTD Permanent and Total Disability
DMO Delegated Management Bodies
MDG Millenium Objectives for development
OMS Millennium Health Goals
UN United Nations
TPO Third-party payment organization
MCP Maternal and Child Protection
PL Public liability
UAS Urgent Medical Aid Service
VAP Likely Present Value
PV Present Value

VIII
 ABSTRACT
The insurance business in the Ivorian market is becoming increasingly competitive. It is
therefore important to find a way to stand out from the crowd and attract customers to one's
portfolio. Although Leadway Assurance already stands out due to its digital nature, it is not the
only player that has opted for digital solutions. There are brokers and even other insurance
companies that are now experiencing digital innovation, allowing them to retain all of their
customers and even attract from other competitors.
It is therefore important to focus on innovation in the products offered in our market. It is
essential for an insurance company newly entering the Ivorian insurance market, such as
Leadway Vie, to put forward relevant and targeted products that meet the real needs of clients.
The health sector represents a real potential for insurers. Nowadays, with technology and
improvements in medical science, life expectancy is constantly increasing. This leads to a
progressive aging of the population, thus modifying the distribution of this population
according to age and giving us, in the long term, a much less young population. The health
insurance industry in the CIMA markets tends to target only the younger part of the population.
This is due to the lack of significant data on the claims experience of consumers in our market.
It therefore seems wise to analyze the claims experience of this target population in order to
offer adequate health coverage while controlling the risk of selling this product at a loss by
defining a financing method. It is within this framework that we have dealt with the theme
relating to the design of an additional health coverage product for a pension scheme with
deferred capital funding. To achieve our objective, we studied the claims experience in the
health sector in order to build a customized coverage plan for retirees. We then defined a
financing plan in the form of life annuities.
Our work consisted in an analytical approach, which was punctuated by recommendations. In
a first part, we made a general presentation of the health coverage system and health insurance
in our insurance market, before proposing, in a second part, the presentation of the different
actors of this project, the construction of the pricing model and the proposal of financing
methods.
The present work was based on our theoretical training in insurance, as well as our professional
experience within the company in which we did our internship.

IX
 INTRODUCTION
With an overall turnover of 390 billion FCFA achieved by 33 companies in 2019 and a
penetration rate of nearly 3%, the Ivorian insurance market represents the leading market in the
CIMA space. Indeed, the first 7 companies with a turnover of more than 10 billion FCFA
represent more than ¾ of the market with nearly 77% of the volume of business (ASACI 2019
data). This rank of market leader in the CIMA zone occupied by Côte d’Ivoire for years would
be due to the strong competition that exists between its various players and the variability of
the products that each of them offers to consumers.

In addition to the good management of the contracts and the speed in the settlement of the
claims that have occurred, one of the things that further characterize an insurance company is
its ability to offer innovative offers available to customers. For a product to be innovative, it
must first come out of the ordinary, and it must meet a very specific customer need. The
difficulty that arises in innovation is above all ignorance of the responsiveness of the population
and the lack of sufficient data to properly price a new product.

The field of insurance presents a peculiarity in its operation which is the inversion of the
production cycle. This particularity automatically generates a fundamental problem which is
nothing other than the determination of the optimal cost of an insurance product. How to choose
the price of a product whose real costs are, at first glance, unknown to the insurer? Thus, it is
important not to set too high a premium while making sure not to sell products at a loss. In
truth, too high a premium could drive customers away and bring them closer to the competition.
A premium that is too low, on the other hand, would expose the company to an excess of
expected charges, which will affect the company's results and at times may lead to a liquidity
or solvency risk.

One of the insurance products practiced but little mastered by insurers is health insurance or
medical coverage. Commonly, the part of the Ivorian population that is entitled to health
insurance is far from being the one that needs it the most. Clearly, health insurance products
seem accessible only to younger people. From retirement, people of advanced age are
deliberately excluded from the target of potential customers for insurance companies This is
due to several factors such as the age of the retiree and the insufficient financial means to afford
medical insurance quality that can actually be in accordance with the needs of the latter.
1
This type of product, which is generally found on our market, is one where the duration of the
contract is already known in advance by the two parties. The one proposed in our study aims
to provide medical coverage for life after the retirement of the insured, which generates an
additional risk of the indefinite duration of the contract. This risk does not represent a constraint
in the other health insurance products that we encounter on the market because the coverage
period is known in advance. However, this product represents a great opportunity for people
preparing to retire because it guarantees them lifetime coverage. This difference with standard
offers can allow an insurer to capture a good share of the market,

More particularly for life contracts such as life annuities, once the contract is in force, the
insurer is required to respect its part of the market until the expiry of the said contract, which
means here until the death of the assured. It is clearly not advisable to take this kind of task
lightly because you are responsible for several cases of financial crisis or even the bankruptcy
of certain insurance companies. This concern for precision in determining the premium for an
insurance product shows us that it is in the best interest of the insurer to set up a tool which
will make it possible to calculate the premium, using various parameters. This process of
assessing the degree of risk is called pricing. In insurance companies, pricing is very often done
by an actuary. In effect, he is the one who will be responsible for carrying out statistical studies
of the market and building an adequate model adapted to the sector in which the company
operates. However, the role of the actuary is not limited to pricing.

Being still new to the Ivorian insurance market, LEADWAY VIE is a fine example of a
company with the interest of developing innovative products that can meet market needs. Since
its launch in 2018, the Nigerian subsidiary has had a difficult start. On the one hand, it had to
take on pre-existing charges linked to the takeover of the former 3A Vie and, on the other hand,
the adaptation to a market that was unknown to them until then. Its objective is to conquer the
Ivorian market by offering innovative services and building customer loyalty by respecting
delivery times. In view of all the above, only one question arises: How can Leadway Vie offer
an innovative product without risk?

It is with a view to answering this question that our subject falls: “Design of an additional
health coverage product for a pension scheme with deferred capital funding”.

The general objective of our work is to define a pricing adopted for health coverage for retirees
and to determine the financing method for this coverage.
2
Specifically, this will be to:

- Analyze health coverage in Côte d'Ivoire;

- Then, identify the definition and detailed implementation of the pricing method for a
health coverage product for retirees;
- Present a judicious pricing of the innovative product

The methods used mainly call on mathematics and law relating to life insurance and, from a
more practical point of view, on computer science. The modeling of the commitments of the
parties to the contract was on the agenda for the calculation of premiums whether pure,
inventory or commercial and the calculation of the insurer's commitments such as mathematical
provisions, redemption and reduction values and profit sharing.

In health insurance, we will use products practiced on the market to make a comparative study
in order to determine an average annual premium of our health coverage for retirees.

Finally, for the computer tool we use a spreadsheet (precisely Microsoft Excel) for the
calculation of all these values.

The rest of our work is based on the assumption that the health insurance products on the market
encounter limits. Thus, the following secondary assumptions follow:

- The target of insurance products excludes a significant part of the population

- Upon retirement, an individual is no longer able to afford quality medical coverage due
to financial instability.

What are the characteristics of the insurance sector? What impact would the offer of this type
of health insurance product for retirees have on Leadway's business?

This subject interests us first of all in the sense that it allows us to participate in the
implementation of a new product within the company and to have a broad knowledge of the
different health insurance products on the market through our research.

This study could be beneficial for all insurers in the CIMA zone given the impact it could have
on the market.

It is to these questions that we will try to provide answers throughout our analysis.
3
To carry out our study, our plan will be divided into two (02) parts.

First, we propose to make a general presentation of the health coverage system and the place
of health insurance as well as some characteristics of our insurance market. In this part, we will
also define the theoretical framework followed by the methodology that will be highlighted
during the construction of the model.

The second part, for its part, will be devoted to the presentation of the LEADWAY VIE
reception structure as well as the other stakeholders of this product: LEADWAY IARD and
ANKARA Services, to the construction of the pricing model and the proposal of policies.
financing of the fund which will be used to provide medical coverage for retirees.

4
PART ONE: THEORETICAL CONTRIBUTIONS

5
Chapter 1: Presentation of the health coverage system

This chapter first deals with the origins and general aspects of health coverage. Second, we will
define the health system and health insurance specifically according to its structure in Côte
d'Ivoire.

Section 1: General information on health coverage

The World Health Organization defines Health as “a state of complete physical, mental and
social well-being, and not merely the absence of disease or infirmity”.

Long before the existence of the current health system, there were several events impacting its
evolution and operation. We will then retrace the origin of the health system as well as its
evolution.

Paragraph 1: History of health coverage

Traditional care is the very first form of health care. The stress level in pre-colonial times was
high. This would therefore explain the high level of mortality at that time. Using practices and
invocations, the pseudo-medicines performed diagnoses and provided herbal remedies.

With the gradual arrival of colonization, we have seen a new form of health care take place.
However, there was strong resistance to this change, which was accompanied by a phenomenon
that could be described as negative.

As far as Côte d'Ivoire is concerned, history will remember these two forms of medicine, being
a former French colony. Traditional medicine was the first form of medicine known to people.
Indeed, before the arrival of modern Western medicine, it was the only form of medicine to
which patients could turn to hope to regain better health, regardless of class. It therefore had
its hour of glory and continues today to attract a good number of Ivorians.

So where are we today? Indeed, since independence, the efforts of governments have been
focused on a better organization of modern medicine which would seem more effective than
traditional medicine.

6
Paragraph 2: Evolution of health coverage in Côte d'Ivoire

1- Evolution of healthcare until 1978

The Ivorian health system was very centralized: University Hospital Centers (CHU), general
hospitals in the regions or large cities, urban and rural dispensaries and a few health centers.
Emphasis was placed above all on curative medicine, preventive medicine being essentially
devoted to the health of the mother and the child: Maternal and Child Protection (MCP). This
policy, which granted a prominent place to modern medicine, made it possible to provide the
population with state structures such as university hospitals, hospitals and dispensaries; which
has favored the accessibility of health structures by a large proportion of the population of
qualified personnel, guidelines to promote public health,
We then had to do with a Welfare State with free healthcare. The State took care of all the care;
and people felt they were being well cared for. However, this health policy represented a very
high economic cost for the State and, moreover, there was an imbalance between urban and
rural areas, and also between the interior regions and the city of Abidjan.

2- Evolution of care from 1978

From 1978, major principles, with clearly defined objectives, were drawn up in order to reduce
the health inequality suffered by developing countries. Côte d'Ivoire has subscribed to these
main principles:
- the Alma Ata declaration in 1978, which challenged the world “to adhere to the
principles of primary health care systems to address the gross health inequalities
between and within countries”. This system was therefore based on primary health care;
- the District approach in 1985: this is the decentralized preventive approach at district
level through the adoption of the development of the health sector based on an
operational unit which is the Health District composed of a general hospital and several
first-line establishments contact. The health district is responsible for the
implementation of primary health care;
- the Bamako initiative in 1987 underlines the need for community participation in health
development with the pricing and recovery of health costs, thus putting an end to the
welfare state. The welfare state died with the Bamako 1987 initiative.
- the Millennium Health Goals (OMS), themselves stemming from the Millennium
Development Goals (MDG) adopted in 2000 by the United Nations.

7
Section 2: Health Insurance in Côte d'Ivoire

This section is dedicated to a more in-depth study of health insurance and the structuring of the
health coverage system in Côte d'Ivoire.

Paragraph 1: Principle and operation of complementary health insurance in Côte d'Ivoire

1- Principle

Health insurance or health insurance aims to protect the insured against the risks associated
with the disease or, more precisely, against all events resulting in medical intervention. It is a
contract by virtue of which the insurer takes charge, in return for the payment of premiums (or
contributions), of the expenses incurred by the insured due to an illness. The elements of the
contract are recorded in documents called “General Conditions” and “Special Conditions”.

2- How health insurance works

It highlights the insurance company, the service provider, the health managers, the
reimbursement methods:

a- The insurance company or the mutual

It is the structure that offers health coverage products to potential customers, namely
Individuals and Corporates. The Individual is an individual or a family made up of the
subscriber and his spouse as well as his children below an age limit. On the other hand,
“Corporate” or Groups refer to organizations or legal persons wishing to cover their members.

This structure is the one that therefore assumes all responsibility for respecting the
commitments defined in the health insurance contract.

b- The provider

This is the body that provides services to customers of insurance companies and mutuals in the
event of claims (relating to health). Some examples of providers are hospitals, pharmacies,
psychiatric centers, clinics, laboratories, etc.

In return for its services, the service provider is remunerated either on the basis of the rates
negotiated and agreed with the insurance companies (or mutuals), or according to the
agreement signed with a health manager.

8
 c- Health Managers

The health manager, also called Tiers Payant, is an establishment acting as an intermediary, on
the one hand between the insured and the service provider and on the other hand between the
service provider and the structure providing the health cover. Clearly, the health manager
replaces the insurance company in the management of claims that have occurred in order to
improve their customer experience. This establishment is remunerated on the basis of the
management fees and commissions of the portfolio of the company or mutual health insurance.

d- Repayment Terms

There are two ways of reimbursing an insured person's medical expenses: direct reimbursement
and reimbursement according to the third-party payment system. Direct reimbursement
consists of the insured person going to the clinic, pharmacy or laboratory and paying for his
consultations, examinations and medication, initially. Then, after having completed and had
the treatment sheet filled out by the service providers, he deposits everything (treatment sheet
and supporting documents) with his insurer or with the third-party payment organization (OTP)
mandated by the insurer who will proceed with the reimbursement. according to the clauses of
the contract: condition, medication and examinations guaranteed, and in proportion to the
coverage rate (70%, 80%, 90% or 100%). Reimbursement according to the third-party payment
system, meanwhile, also tells the insured to go to the clinic, at the laboratory or at the pharmacy
with his health insurance card. But this time, the latter only pays the cash register for the part
that is his responsibility, called "copayment moderator" according to the clauses of his contract
(20% or 10% or 0% for 80%, 90% or 100%). The service provider will later be paid directly
by the insurer to whom he will send all of his invoices.

Paragraph 2: The structure of the health coverage system in CI

The organization of the health system in Côte d'Ivoire reflects the supply of care put in place
to respond to a better structured demand for care. The Ivorian health system is of the pyramidal
type with two sides: the administrative side and the side providing care.

1- The administrative slope

It has three levels which are:

9
 - The central level: This level includes the Cabinet of the Minister, the attached
services which are attached to it, two General Directorates and 8 Central
Directorates.
- The intermediate level corresponds to the 19 regional directorates, responsible for
coordinating the activities of the health services located in their territorial
jurisdiction, with regional hospitals.
- The peripheral level made up of 85 health districts, 79 of which are functional,
which constitute the operational level of the system. The health district corresponds
to the administrative department. The health district is responsible for the
implementation of primary health care. Each health district is home to a network of
first-level structures (First Contact Care Establishments) and one or more general
hospitals.

2- The care offering side includes:

The healthcare offer side has three (3) sectors which are themselves composed of different
levels. These are the public, private and traditional medicine sectors.
a- The public sector
This sector is subdivided into three levels which are:
- A primary level: made up of first contact health establishments, the entry point into
the health system and which are the health centers (urban and rural) and urban
health units;
- A secondary level represented by the first resort or reference health establishments
for patients coming from the primary level. This secondary level is made up of
general hospitals, Regional Hospital Centers and certain Specialized Hospital
Centers;
- A tertiary level made up of health establishments providing a second and last resort
function. This level includes the 4 University Hospital Centers (CHU), the
Cardiology Institute of Abidjan (ICA), the Raoul Follereau Institute (IRF) of
Adzopé, the National Institute of Public Hygiene (INHP) of Treichville, the Urgent
Medical Aid Service (UAS) of Abidjan and the National Institute of Public Health
(INSP) of Abidjan.

10
 b- The Private Sector
Clinics and private practices take part in providing healthcare to populations. If some of
them are as much if not better equipped than public formations, others on the other hand
constitute real dangers. However, access remains limited.

c- Traditional Medicine
It is an important part of the healthcare offer and is widely used by the population. However,
the nature of the products dispensed being often unknown to the uninitiated, its
popularization remains problematic. A control and better organization of this sector has been
undertaken which, initially governed by a sub-directorate at the Ministry of Public Health,
has become a National Program for the Promotion of Traditional Medicine.

3- Forms of health coverage

a- CMU: Universal Health Coverage

Universal Health Coverage, known as CMU, is a compulsory national social protection system
against the risk of illness. The main objective of this system is to guarantee that all resident
populations in Côte d'Ivoire have access to quality health care.
This coverage officially entered its operational phase on January 1, 2020, even if it had already
been effective since October 1, 2019. Compulsory national health risk coverage system for the
benefit of populations, starting with the most deprived, the CMU has aims to guarantee all
Ivorians residing in Côte d'Ivoire access to quality health services and care at a lower cost.

The rate of coverage has been set at 70%, the insured beneficiaries only pay a moderator fee of
30% of the medical service, whether it is a consultation, a surgical intervention or even
purchase of drugs.

Two schemes have been put in place: a general basic scheme, contributory, at the rate of 1,000
CFA francs per month and per person (which also benefits any eligible beneficiaries), as well
as a medical assistance scheme, non-contributory, for the poor, who until now have mostly
been excluded from the health system.

The social security institution: CNAM

To ensure the implementation of this CMU, the legislator has provided for the creation of a
Social Welfare Institution responsible for managing and regulating the CMU system. This

11
institution, which is the National Health Insurance Fund, was created by Decree No. 2014 –
395 dated June 25, 2014. It is administered by a Board of Directors and headed by a General
Manager.
The CNAM is a light structure for piloting and regulating Universal Health Coverage,
accompanied in its mission of managing CMU by a set of operational and institutional actors.
The CNAM therefore delegates part of its functions to the Delegated Management Bodies
(DMOs) which are structures with expertise in the management of social risks (CNPS,
CGRAE, Mutuals, Commercial Insurance, Health portfolio managers, etc.). The delegation
may relate to:
- Either on functions related exclusively to the attachment of the persons covered, to
the collection and repayment of the contributions collected to the CNAM;
- Either on functions related exclusively to the management of services (medical
control, settlement of invoices and authorization of payments to healthcare
providers);
- Either on functions that combine the attachment of the persons covered, the
recovery and the management of benefits.

IPS-CNAM is responsible for ensuring:

- the management of schemes created under the law instituting Universal Health
Coverage;
- the management of all special programs, including on behalf of third parties, the
purpose of which contributes to better management of the health risk;
- the collection of contributions and the provision of benefits relating to these various
schemes;
- the management of funds collected under the plans of the Universal Health
Coverage system;
- the regulation of Universal Health Coverage.

b- Additional coverage
The complementary health is the offer proposed by the mutual and the health insurance.
Depending on the level of guarantees desired, whether you have taken out a health insurance
contract or a contract with a mutual insurance company, you will obtain reimbursement of
medical expenses in addition to those of Social Security (CMU). Complementary health

12
 insurance can also reimburse acts not covered by Social Security, such as osteopathy sessions
and other alternative medicines.

A mutual
A mutual is a non-profit company registered in the national register of mutuals. The insured
are solidary with each other and the profits must be returned to them. The purpose of the mutual
health insurance is to supplement Social Security reimbursements. The guarantees of the
mutual health insurance are chosen by the insured person according to his needs and his state
of health. Several levels of cover are offered, particularly with regard to dental, optics and
hospitalization.

Health Insurance
The difference between mutual and private insurance lies in the fact that the first is a non-profit
company, which is not the case of the second. The health insurance company is an insurance
company in its own right which measures a risk in order to determine the amount of the
contributions. It can generate profits and appeal to shareholders. Governed by the Insurance
Code (CIMA), its operation is closer to a traditional company than that of a mutual insurance
company.

Table 1: Comparison of Additional Health Coverage

Mutual health Health Insurance company

Non-profit profit
No benefits, pooling of contributions Profits returned to shareholders
No age, resource or health condition May ask for a health questionnaire to estimate risk

Source: The Student

13
Chapter 2: Principle of the deferred financing health insurance product

This chapter focuses on the presentation of the approach used in the rest of our work. This will
involve presenting the life annuity products and demonstrating the reasons for taking an interest
in the deferred life annuity product for the determination of our health product for retirees.

Section 1: Presentation of life annuity products

This part develops general information on life annuities and some reminders on the technical
aspect of life annuities.

Paragraph 1: General information on life annuities

1- Definitions and Characteristics

The simpler, traditional annuity product provides guaranteed regular payments to an individual
in exchange for an initial non-refundable premium. This product thus guarantees a stable
income to the individual and protects him against the risk of depleting his retirement assets.
This basic annuity structure, however, can vary along several dimensions: the timing of
payments, the timing of premiums, and whether the product is sold at an individual or group
level.

Premiums for annuity products can be paid all at once, as a single premium, or split into regular
premium payments. Single premiums are typical of immediate annuity products, while regular
premium payments are more common for deferred products, allowing individuals to contribute
over time and increase the level of future income, much like other retirement savings products.

Longevity risk is the most common risk associated with annuity products because annuity
products that provide payouts throughout an individual's lifetime insure against the longevity
risk of outliving their assets in retirement.

Annuity products can also provide a guaranteed payout to surviving beneficiaries of an

annuitant in the event of death. This may be a lump sum payment contingent on the death of
the annuitant, a lifetime payment to the surviving spouse, or a guaranteed period where
payments continue for the specified number of years regardless of the survivor's survival.
annuitant.

14
 2- Types of life annuity products

Annuity-type products are generally retirement formulas such as pensions. But how they work
can vary depending on several factors. In the case of a life annuity, the condition for this amount
to be paid depends on the life of the insured. Clearly, as long as the insured is alive, the insurer
must pay a fixed and periodic sum to the latter.

There are several types of life annuities:

a- Immediate life annuities

This type of annuity is with immediate effect as soon as the constituent capital of the annuity,
also called Single Premium, is paid to the insurer.

b- Deferred life annuities

Deferred annuities entitle the insured to receive periodic annuities after a pre-defined
period, also called the capitalization or contribution period. This form of life annuity allows
the insured to gradually build up his capital.

c- Joint life annuity

The life annuity is said to be reversible when it provides for the maintenance, after the death
of the insured, of the payment of all or part of the annuity for the benefit of a third party until
his own death. It therefore makes it possible to preserve the standard of living of one's spouse
or loved one through the regular payment of a sum of money. The amount of the annuity paid
back is fixed by the reversion rate for which the subscriber has opted, it is generally 60%, 80%
or 100%. The initial amount of the annuity depends on the capital accumulated at the time of
the conversion into an annuity, the reversion rate chosen and the life expectancy of the
beneficiary. As in the first two cases, it can be effective immediately or deferred.

d- Tiered life annuity

The life annuity in stages makes it possible to modulate the amount of the annuity over several
defined periods, upwards or downwards. The insured can choose:
- Or to increase the amount of his pension during the first years of his retirement,
with the prospect of a lower pension thereafter. This alternative can be particularly
interesting if the subscriber still has dependent children or an outstanding loan at

15
 the time of his retirement, in order to benefit from a higher income in the first years
of his cessation of activity.

- Or to reduce the amount of his pension during the first years of his retirement to
benefit, thereafter, from a higher additional income. This solution is particularly
judicious in the case where the retired subscriber has to face a new significant drop
in income when his spouse in turn retires.

- The coefficients of variation of the annuity, the duration of the associated periods
and the number of levels depend on the contract that the insured has taken out and
are generally determined by the insured at the time of the transformation of his
savings into an annuity. Not all contracts are equal in terms of flexibility, so it is
essential to check the annuity conditions in the contractual documentation.

e- Annuity with guaranteed annuities

The annuity with guaranteed annuities ensures that the subscriber receives an annuity for a
fixed number of years. If the subscriber dies before the end of the guaranteed annuities, the
remaining annuities will be paid to the beneficiary he has designated. These annuities will be
paid in the form of an annuity, equal to the amount of those paid to the insured during his
lifetime. The number of guaranteed annuities is generally limited by the number of years of life
expectancy of the subscriber at the time of conversion into an annuity, reduced by 5 years.

f- The annuity with long-term care guarantee

This option makes it possible to benefit from a supplementary pension, which is added to the
initial pension, in order to cope with a loss of autonomy during retirement. The saver can then
more easily meet the expenses related to this dependency.

3- Risks associated with life annuity type products

The different types of annuity products, and the guarantees and options they offer consumers,
present many risks that must be understood and managed by the annuity provider, as well as
policymakers, to ensure of appropriate regulations. This section provides more in-depth
descriptions of the types of products presented in the previous section, and explains in detail
how the risks presented by these products can be managed and mitigated.
16
The main risks faced by insurers are longevity and investment risks. Inflation is also a
significant risk for products whose payments are indexed to the cost of living. Products that
offer greater flexibility to the customer may present an increased risk with respect to consumer
behavior. Other risks such as underwriting risk, expense risk, operational risk or legal risk are
more common across all product lines, although the drivers of these risks for annuity products
may differ.

a- Longevity risk
Longevity risk has traditionally been one of the most significant risks for annuity providers, as
annuity payments are promised for the lifetime of the individual. Longevity risk is a very long-
term risk induced by uncertainty surrounding estimates of future mortality improvements. The
insurance company is exposed to the risk of underestimating mortality improvements and
resulting increases in life expectancy, forcing it to make payments longer than expected.

b- Investment risk
Investment risks may also be material to the insurer. Interest rate risk, in particular, can be
material for fixed-payment annuity products, and relates primarily to the potential mismatch
between the duration of assets held to secure annuity payments and the duration of liabilities.
The duration of the liabilities is generally longer, which exposes the Insurance to the
reinvestment risk of interest rates which will have fallen when the assets, such as long-term
bonds, mature. Active asset and liability management (ALM) is needed to manage this risk and
minimize the duration gap between assets and liabilities. Stress testing can be a useful tool to
assess the potential impact of changes in the rates of

c- Interest rate risk

Interest rate risk compounds the effect of longevity risk on annuities, and the impact of low
interest rates and longevity risk is greater than the sum of the two, because low interest rates
give greater weight to the future and the risk of longevity increases with the time horizon
considered. Consequently, the current economic environment of low interest rates may increase
the risk exposure of insurance companies offering life annuity products.

17
 d- Inflation risk
Inflation risk for inflation-linked annuities is obvious because it increases uncertainty around
the level of future payments, and like interest rate risk, it is compounded by the existence of
longevity risk. Inflation risk can, however, be managed by purchasing inflation-indexed bonds,
although these instruments are not available in all jurisdictions. The limited availability or
absence of inflation-indexed bonds could pose a problem for annuity providers offering
inflation-indexed annuities.

Paragraph 2: Reminders of some actuarial principles and Operation of life annuities

1- General
Life annuity pricing essentially depends on the age of the insured. The duration of the contract
will only depend on when he signs the contract and when he dies. Since this information is
unknown, the insurer makes assumptions to determine the life expectancy of the insured.
In addition to the age of the insured, we must take into account the factor of accumulation over
time. From these facts, there are three elements used for the calculation of the tariffs:
- a technical rate
- mortality tables
- loadings

The technical aspects of pricing (technical rate and mortality table) and provisioning are
governed by the CIMA regulatory code.
Article 338 titled “Mortality tables and interest rates” stipulates:
"The tariffs submitted for approval by the Minister in charge of insurance by life insurance
companies or to the Regional Insurance Control Commission by this authority must, subject to
the provisions of Article 338-2, be established 'after the following:
- The mortality tables CIMA H for insurance in the event of death and CIMA F for
insurance in the event of life, appended to this article;
- The interest rate at most equal to 3.5%.
- These tariffs must include loadings allowing the recovery by the company of a
justifiable and reasonable amount of costs. »

18
The operation varies according to the type of guarantees and the nature of the life annuity. We
will provide in this section some theoretical cases of life annuities that we will have to
implement in part 2 of our work.

2- Reminders of actuarial principles

a- Deferred capital without counter-insurance

An insured of age x at t = 0 wishes to receive capital S, n years later if he is still alive at that
time. In order to meet this commitment, the insurer must request:
!!"# !
!!
∗ 𝑣 " ∗ 𝑆with which represents the probability of the insured of age x to survive n years. !"#
! !

In switching form, this gives us:

! # !"# ∗!!"# %!"#
*S. !"#
!
∗ 𝑣" ∗ 𝑆 = # ! ∗!!
∗𝑆 = %!
∗ 𝑆 = " 𝐸&
!

" 𝐸& is the probable present value (VAP) of a capital of 1 CFA deferred by n years, without
counter-insurance.

b- The life annuity

It is paid as long as the beneficiary is alive.
- Probable current value of a life annuity paid in arrears:
+!"$
. In commutation form, this gives us: ∑(
')* ' 𝐸& = 𝑎& 𝑎& = %!
+
- Probable current value of a life annuity paid at an early date: 𝑎& = %!
!

a- The deferred life annuity

- Deferred life annuity of m years, temporary of n years, paid in arrears
,0"

,| 𝑎&:"⌉ = ) ' 𝐸& = , 𝐸& ∗ 𝑎&0,:"⌉

'),0*

- Life annuity deferred for m years, temporary for n years, paid in advance:
,0"

,| 𝑎&:"⌉ = ) ' 𝐸& = , 𝐸& ∗ 𝑎&0,:"⌉

'),0*

c- Case of the split annuity

Most of the time, an annuity is not paid by annual arrears. More generally, we consider
payments of 1/k FCFA made every kth of a year:
- Split annuity in arrears:

19
 2∗"
𝐷&0 '
(2)
1 2 𝑘−1
𝑎 &:"⌉ = , ≈ 𝑎&:"⌉ + (1 − " 𝐸& )
𝑘 𝐷& 2𝑘
')*

- Early split annuity:

2∗"4*
𝐷&0 '
1 2 𝑘−1
𝑎̈ (2) &:"⌉ = , ≈ 𝑎&:"⌉ + (1 − " 𝐸& )
𝑘 𝐷& 2𝑘
')5

3- Notions of Prime Pure and loadings

a- The notion of Pure Premium

The Pure Premium of a classic life insurance contract is determined by writing that the VAP
of the commitments of the insured and the insurer are equal on the date of subscription of the
contract. We deduce the equation for calculating the pure premium of a life contract:

VAP (insured) = VAP (insurer) on the date of subscription of the contract.

Thus, to calculate the pure premium, it is necessary to determine the VAP of the commitments
of the insured and the insurer. The valuation of these commitments at the origin of the contract,
that is to say the calculation of their VAP, requires on the one hand, the calculation of the
present value of these commitments (therefore the fixing of a rate of interest over the duration
of the contract) and on the other hand the calculation of the probability of realization of these
commitments (therefore the calculation of lifetime probabilities). The amount equal to the
probable present value of the insurer's future liabilities is called the pure single premium:

- Pure premium paid in one go by the insured: pure single premium

- Pure premium paid at regular intervals: pure periodic premium
The pure premium corresponds to the pricing of the insurer's commitments to the beneficiary.
This pure premium does not include the financing of commercial costs and management costs
borne by the insurer. To meet these costs, the pure premium will be increased by loadings by
the insurer.

20
 b- Loadings
The final premium communicated to the insured is called the commercial premium or the
premium including tax. It is made up of the pure premium by adding to it a set of elements that
will be called loadings as well as the taxes incurred by the insurance company because of its
exercise in the CIMA zone.

Definition of loadings

These are sums that supplement the pure premium to enable the insurer to cover all the costs
of all kinds that it is obliged to incur to market contracts and manage them. Setting their amount
when launching a new company or designing a new product is a delicate task for the actuary.
Insurance regulations in the CIMA zone allow the insurer to choose their amount, unlike the
other tariff bases, which are the mortality table and the technical interest rate. The insurer must
take great care in determining the amount of loadings because these contribute to the company's
results and an under- or over-estimation of their amount influences the company's accounts.

The main charges commonly applied are defined according to the nature of the costs they are
intended to cover. Thus, we distinguish:

- acquisition charges intended to cover contract acquisition costs (commissions, marketing

costs, etc.).

- management charges intended to cover general expenses (excluding commissions) of any

kind incurred by the insurer.

In addition to these commonly practiced classic loadings, certain insurers, depending on the
nature of their contracts, the status of their company and their commercial network, levy
additional loadings.

Insurer management charge and overheads

When designing a contract, the management charges included in the amount of the total
premium paid by the subscriber are intended to cover the general costs actually incurred by the
insurer to ensure the operation of the company (salaries, FDG , etc.). The actuary fixes the
amount included in each premium so that it covers at least the general expenses of the insurer.
He must calculate them at the design of the contract, while the general costs of the insurer are
21
only known with accuracy after several years of operation and if the insurer has clear and
detailed cost accounting by type of contract. and by item of expenditure. The actuary can
proceed by adjusting the amount of the loadings over the accounting years. Thus, for a given
category of contracts,

Acquisition charge and commissions paid to contributors

When designing a contract, the acquisition charges included in the amount of the total premium
paid by the subscriber are intended for the payment of the commissions of the contributors.
The actuary sets the amount of acquisition charges included in each premium so that it is at
least equal to the amount of commissions actually paid to sales agents. Once the amount of
commissions included in each premium is known, the insurer chooses one of the following
ways to remunerate contributors:

- pay commissions over the premium payment period as they are

collected. We are talking about undiscounted commissions.
- pay at the subscription of the contract all the commissions provided
for in the contracts (taking into account the duration of payment of
the premiums and the probability of their payment). This is the
commission discount
- pay all the commissions provided for in the contract during the first
years of its existence (generally during the first three years) by
setting commission factors per year. It is the partial discounting of
commissions which is an intermediate method between the two
previous ones. In summary, we have the following equalities:
- Pure Bounty (P) + Management Loadouts = Inventory Bounty
- Inventory Bonus + Acquisition Fee Charge = Trade Bonus

c- Calculation of inventory and commercial premiums

To summarize, we can note the different loadings mentioned as follows:

- g1= premium management charges (deducted during the premium

payment period p and expressed as a % of guaranteed capital)
- g2= contract management charges (deducted during the term n of the
contract and expressed as a % of the guaranteed capital)
22
 - f= acquisition loads (% trade premium and undiscounted)

We will also note the duration of a contract as n and the annuity which acts as
a guarantee as R.

Inventory bonus
The inventory premium is then determined as follows:

Annual inventory bonus (PAI) = P + C*g1 + C*g2*(ú näx / ú päx)

Or Unique Inventory Bonus (PUI) = P + C*g2 *ú näx

Commercial bonus

Commercial annual premium (PAC) = P' / (1- f)

Section 2: Similarities and Differences with Deferred Funding Health

Coverage Product
This next section will deal with the role that the technical aspect of deferred life
annuities plays in the continuation of our work by demonstrating the similar
elements that they share.

Paragraph 1: Complementary retirement group contracts

1- Defined contribution pension contracts
a- Object

This contract allows a company to set up, for the benefit of all or part of its staff,
a supplementary pension in the form of a joint life annuity or not. Very often,
the benefits are irretrievably acquired by the employee even if the latter leaves
the company or dies before retirement.

b- Contributions

Contributions are fixed as a percentage of the monthly salary. The contribution

rate is uniform for all employees or by category. This rate may include a share
of the Employer and a share of the employee, or paid in full by the employer.
The choice of the contribution rate is not final, it can vary up or down,
depending on the company's social policy. Contributions are deducted monthly

23
by the company for all the employees concerned. They are then paid in full to
the insurance company.

c- Management during the activity period

For each active employee, the insurer opens an individual account funded
(during the employee's period of activity) by contributions net of loading,
interest and profit sharing. Thus each individual account functions exactly as an
individual savings contract.

d- Retirement management

The payment of the pension occurs when the member reaches retirement age,
or when he becomes disabled. At this time, the capital saved, known as the
annuity constituent capital, is converted in the form of an annuity in arrears
(under the conditions in force on that date: technical rate, mortality table and
loadings) paid during the lifetime of the insured according to a periodicity. The
insured can choose the option of reversibility of the annuity. The payment of
the pension then continues for the benefit of the spouse.

2- Defined benefit retirement contracts

Defined-contribution group pension contracts guarantee the employee arriving

at retirement a deferred income which depends on the actual contributions he
has paid while he was working and which has no connection with his last
income at his retirement. . This is a major drawback for these contracts. For
these contracts, the means (contributions) are well defined (hence the name
defined contribution pension), but the benefits at term depend on these
contributions. To overcome this drawback, life insurers have set up group
pension contracts known as defined benefit contracts guaranteeing all the staff
of a company or a category thereof, an income or pension equal to a certain
percentage of the employee's salary upon retirement.

24
 a- Object

Defined-benefit retirement contracts guarantee all or part of a company's staff a

supplementary pension in the form of a life annuity equal to a certain percentage
of the last salary.

b- Contributions

In defined benefit pension contracts, the contributions are determined following

an actuarial study based on the following elements: the evolution of salaries, the
dates of birth of the employees, the seniority of the employees and the
probability of the employee's presence. at the time of his retirement.

Thus, in such contracts, the amount of the contributions cannot be determined

in advance. Initially, the insurer will make an assessment of the amount of the
contributions which it will adjust regularly according to the evolution of the
parameters above.

c- Management during the activity period

The insurer creates a collective fund. The contributions paid by the contractor
(less expenses), interest and participation in the technical and financial profit
will feed the fund. When an employee reaches retirement, the constituent capital
necessary to liquidate the retirement of said employee is deducted from the fund.
Unlike defined contribution pension contracts, the insurer does not set up an
individual account for each employee. Here, the contributions are not
individualized. They form a single global account called a collective fund.

d- Retirement management

Here the amount of the pension is predetermined (generally equal to a

percentage of the end-of-career salary, the method of calculation of which is
defined in the contract). The insurer will calculate the constituent capital of the
annuity according to the tariff in force. Once the constituent capital has been
calculated, the insurer deducts the amount from the collective fund dedicated to
the contract and allocates it to a second fund called the “annuity service fund”.

25
Paragraph 2: Comparison with the deferred financing health insurance product

This product consists of defining a benefit table that will serve as the basis for
our pricing. In other words, the benefit is known in advance and will therefore
determine the amount of contribution payable by each employee.
1- The commitments of the insured
The insured will have to contribute a fixed amount or not, depending on the
case, throughout his function. That is to say, during a period which starts from
the moment of subscription until the retirement age at the most. From retirement
age, each insured person and their dependents will receive health cover. As a
result, the contribution period takes the form of a deferred one and therefore has
similarities with the deferred life annuity which also consists in making the
subscriber pay periodic premiums in order to constitute a fund which will be
used to finance the retiree's pension.

2- The insurer's commitments

The insurer is required to provide, from the retirement age of each individual,
health cover, the guarantees of which are defined in advance, until the end of
the retiree's life. The benefit table, on the other hand, remains the same over the
years. Unlike conventional life annuity products, this product offers benefits in
kind.
Summary table :

26
 Table 2: Summary of the characteristics of complementary health products

Defined contribution plan

Defined Health
Defined benefit plan
Coverage Plan

life annuity Nature (Benefits of

life annuity
Healing)
Guarantees
The retirement benefit is determined
offered The retirement benefit is
on the basis of the savings acquired The retirement benefit is
defined in advance
by the capitalized contributions defined in advance
Compulsory for all or a category of Compulsory for all or a
Form of
staff defined by an objective category of staff defined Not required
membership
criterion by an objective criterion
The company
The company must participate in all The company finances participates or not
Funding
or part of the financing alone voluntarily part of the
financing
Acquired rights are certain. They Acquired rights are Acquired rights are
Acquired remain acquired by the employee virtual. They are lost in virtual. They are lost in
rights even in the event of departure from case of departure from case of departure from
the company. the company the company

Source: The Student

In short, we can remember in this first part that the health system in Côte d'Ivoire has
experienced two major stages since its arrival during the colonial period. It is now composed
of a mixture of traditional and modern services. Because of the weight that this represents for
the State, there are structures offering additional coverage, also called insurance companies or
mutual insurance companies. We then defined an approach allowing us to offer a product that
could overcome the problem of inaccessibility of the current services of health insurance
players to retirees.

27
PART TWO: IMPLEMENTATION OF THE PRICING
MODEL

28
In the next part of this work, we will proceed to the implementation of the pricing model of our
health product after having presented in detail the host structure as well as the other actors of
the project implemented in this thesis.

Chapter 3: Presentation of the stakeholders of the deferred financing health product.

Section 1: Presentation of the different actors

This section is reserved for the general presentation of Leadway Vie, Leadway Assurance
IARD and ANKARA Services; these three structures will each play a specific role in the
realization of this project.
Paragraph 1: The host structure: Leadway Vie
1- History of Leadway Vie, a subsidiary of Leadway Assurance Company

Leadway is one of the leading insurance companies in Nigeria, licensed by the National
Insurance Commission (NAICOM) to conduct life and non-life insurance business. Leadway
is renowned for its integrity, quality of service, respect for the individual and excellence. It was
established in 1970 by Hassan O. Odukale and started operations in 1971 and started as a direct
automobile insurer. It expanded into other general lines of business until it became a composite
company underwriting both life and general insurance. The financial capacity of the company
has increased over time, and it can now underwrite very large risks for heavy industries, such
as oil and gas and large manufacturing companies. It also offers subsidiary financial services
such as bonds, secured loans, miscellaneous financial losses and fund/portfolio management.
The company is now headed by Tunde Hassan-Odukale.

For 50 years, Leadway has honored its underwriting commitments and earned its reputation for
excellence in claims handling. Leadway's evolution since 1970 has reflected the dramatic
expansion of local insurance service providers, with Leadway remaining at the forefront as a
reputable insurer. The reputation that Leadway enjoys today has been achieved by the
continuous pursuit of improvements to maintain a competitive advantage. All aspects of the
business are approached with discipline: the recruitment of personnel, the development of
products, the advancement of technologies and the personal service offered to each client.

The Nigerian company has a specifically digital and technology-oriented marketing strategy.
This strategy aims to improve the customer experience and bring customers closer to their
insurer, thus creating digital channels acting as a link between the insured and the insurance

29
products offered. It also aims to improve the accuracy of product prices and technical
provisions made for them thanks to the large amounts of data collected over time.

This strategy has allowed us to provide access to our customers on all platforms via a secure
network and to have a 360 degree view of the customer.

Leadway is rated AA- (Stable) in 2017 by Global Credit Rating (GCR). According to GCR

The following companies are subsidiaries of Leadway Assurance Company

- Leadway Pensure PFA Limited: This company was incorporated on 25th August
2004 and was formally authorized by PENCOM on 7th December 2005, in
accordance with the provisions of the Pensions Reform Act 2004 to carry on the
administration of pension funds [PFA ]. Leadway Pensure is one of the leading
pension fund administrators in Nigeria.
- Leadway Vie: Leadway Vie is an insurance company authorized by CIMA to
provide life insurance services in Côte d'Ivoire.
- Leadway Hotels Limited: It is the hospitality and accommodation subsidiary of
Leadway Assurance Company Limited officially established in 2005. It has three
notable and successful businesses in Lagos and Abuja namely Leadway Hotel Ikeja,
Leola Suites and Panache Restaurant. Its goal is to become a recognized brand in
the hospitality industry.
- Leadway Capital & Trusts Limited: This subsidiary was incorporated on March 22,
1995 as Leadway Trustees Limited, but its services were commercialized in 1999.
The company was established primarily to provide trust services to corporations,
government and its agencies, multilateral organizations and individuals. The
Company is also registered with the Securities & Exchange Commission as a
fiduciary to enable it to operate in the capital market.
- Leadway Properties & Investment Limited: a property development company
specializing in the acquisition, development, management and sale of high quality
commercial and residential properties in the Nigerian property market. To date, she
has only developed and managed Leadway-owned real estate assets nationwide.

Leadway has received several awards over the past few years. The most notable are:

30
Table 3: Awards of Excellence received by Leadway

PRIZE NAMES YEAR AWARDING BODY

Best use of Social Media (Twitter) 2016 Philips Consulting
Overall best use of Social Media 2016 Philips Consulting
Best Customer Service Insurance Company 2016 Nigeria Customer Service
2015 Awards
2013
Annual Corporate Citizens Award 2015 Corporate Affairs Commission
Best use of Music – Leadway Tears TV 2015 LAIF Awards
Best Nigerian Financial Service Provider in 2012 CBN/Bill Gates Foundation
Volume and Efficiency of Direct Credit
Payments

Source: The Host Company

2- The subsidiary Leadway Vie

Leadway Vie is one of the ten (10) life insurance companies operating on the Ivorian market
in 2019. Its head office is located in Abidjan-Plateau, Boulevard Botreau Roussel, Immeuble
SUNU 6th floor. It is a public limited company under Ivorian law whose share capital amounts
to eight billion five hundred million (8,500,000,000) FCFA. It is a subsidiary of Leadway
Assurance Company Limited which is one of the main insurance companies in the Nigerian
market and is even the leader with more than 50 years of experience in the field of Life and
Non-Life insurance.

It entered the Ivorian market in 2018 through the acquisition of the African Insurance Alliance
and achieved during the last three years of the financial year the turnover of 1,106 million
FCFA in 2018, 1,415 million FCFA in 2019, 1,196 million FCFA in 2020 and 2,059 million
FCFA in 2021. It therefore occupies 1.00% of the Ivorian life insurance market according to
figures from the Association of Insurance Companies of Côte d’Ivoire (ASACI). Since
December 13, 2021, Leadway Vie has become the majority shareholder of Leadway Non Vie,
a new subsidiary of Leadway Assurance Company Limited with a share capital of five billion
(5,000,000,000).

31
The main objective of the Leadway group is to quickly climb the ladder and become the leader
of the Ivorian market with its new subsidiary in the life insurance branch, currently ranked
ninth.

Table 4: Turnover of the Life Insurance branch in 2020 and 2021

Turnover 2020 Turnover 2021 Market
Rank Society Variation
(millions FCFA) (millions FCFA) share
1 SUNU VIE 54,447 60 219 10.6% 29.71%
2 NSIA VIE 35,035 41 107 17.3% 19.12%
3 ALLIANZ VIE 27,629 30,408 10.1% 15.08%
4 SAHAM VIE 26,100 26,803 2.7% 14.24%
5 WAFA VIE 9,950 14,299 43.7% 6.12%
PRUDENTIAL
6 10,927 12,893 18.0% 5.96%
BELIFE
ATLANTIQUES
7 8,467 8,571 1.2% 4.62%
VIE
8 LOYAL VIE 7,390 8,016 8.5% 4.12%
LEADWAY
9 1,196 2,059 72.1% 0.68%
VIE
10 SAAR VIE 623 623 0.0% 0.34%
TOTAL 181,764 204,997 12.8% 100%

Source: SIKA Finance data, 2022

Leadway Vie is made up of a general management and five (5) main departments:

• The Administrative and Financial Department;

• The Customers and Individuals department;
• The Marketing and Distribution department;
• The Commercial Department;
• Technical department

32
 Diagram 1: Leadway Vie Organizational Chart

MANAGING DIRECTOR
TIORNAN COULIBALY

SALES DIRECTOR MARKETING DIRECTOR CTO CFO

MARIAM MCKINNEY ROSINE VONAN KINGSLEY MILLER ERNEST OCHONOGOR

HEAD OF
HEAD OF RETAIL ACTUARIAL LEGAL/COMPLIAN
CLIENT SERVICE COMMUNICATION HR/ADMIN NTIC FINANCE INTERNAL
SALES DEPARTMENT CE
1 2 1 1 4 CONTROL
9 SAMUEL GBARI 1

AGENTS CALL CENTER ACTUARIES DRIVER

150 5 2 2

FRONT DESK
3

QUALITY
ASSURANCE
3

Source: The Host Company

3- The subsidiary Leadway Assurance IARD

Leadway Assurance Company Limited, after a new contribution in cash to the share capital of
its subsidiary Leadway Vie in the amount of 5.5 billion fully paid-up CFA francs, has decided
to diversify its activity in Côte d'Ivoire by creating a non-life insurance company called
“Leadway Assurance IARD”.

This decision aims to create a complementarity of activities, so that a customer who contacts
Leadway has the possibility of finding all his insurance needs with the same group. The two
companies will thus be able to create a synergy favorable to the development and influence of
the LEADWAY Holding. Expenses may be shared and packages of life and non-life products
may be offered to group and individual customers.

Leader in Non-Life and Life insurance in Nigeria with a turnover of 90.6 billion Naira at the
end of 2019, i.e. 130.2 billion CFA francs, Leadway Assurance has fifty (50) years of solid and
rich in life and non-life insurance. The operating result at the end of 2019 amounted to 10.8
billion Naira or 15.7 billion CFA francs.
33
 The Ivorian Non-Life insurance market with twenty-one (21) players has seen five new entrants
over the past four years. With new players in the sector achieving an attractive growth rate,
Leadway Assurance IARD believes in its potential to positively impact the market through
innovation and its customer relationship management approach.

Leadway Assurance IARD obtained its license on December 13, 2021 and officially begins its
activities from April 2022. This insurance company aims to be a very short-term digital
insurance company. In the long term, it aims to be the leader of the insurance market in Côte
d'Ivoire. The management team of Leadway Assurance IARD will be the same as that of
Leadway Vie. Nevertheless, a project manager with solid experience in non-life insurance has
been recruited to supervise the activity. General management will be occupied by Mr. Tiornan
Coulibaly who is also Director and Chief Executive Officer of Leadway Vie.

Diagram 2: Organization chart of Leadway Assurance IARD

MANAGING DIRECTOR
TIORNAN COULIBALY

SALES DIRECTOR MARKETING DIRECTOR CTO PROJECT MANAGER CFO

MARIAM MCKINNEY ROSINE VONAN KINGSLEY MILLER PARFAIT KOUASSI ERNEST OCHONOGOR

COMMUNICATI HR/ADMIN NTIC FINANCE

HEAD OF SALES CLIENT SERVICE HEAD OF ACTUARIAL LEGAL/COMPLIANCE INTERNAL
ON HEAD OF CLAIMS
9 1 DEPARTMENT UNDERWRITING MANAGER 1 1 4 CONTROL
2 1
SAMUEL GBARI

AGENTS CALL CENTER DRIVER

ACTUARIES HEALTH
150 5 UNDERWRITER 2
2

FRONT DESK
NON-LIFE
3 UNDERWRITER

QUALITY
ASSURANCE
3

Source: The Host Company

4- Ankara Services
Also part of the Leadway Assurance Company Limited group, Ankara Services "Ankara" is
the third CIV subsidiary of the said group. This structure officially launched its activities in
Lagos (Nigeria) and Abidjan (Côte d'Ivoire) in January 2021 and July 2021 respectively.
Ankara Services Côte d'Ivoire is a "Limited Company" with a capital of 10 million CFA francs
, fully released at creation. She is one of the pioneers in Dematerialized Health Expenditure
Management in West Africa, fully dedicated to proactively meeting the needs of her clients
across the African continent. Their goal is to increase the penetration of Health Insurance and

34
access to quality health care by offering effective services and solutions allowing our customers
to focus on their core business and no longer worry about their medical care and that of their
dependents, while controlling their budget. Ankara Services CIV is currently managed by
Coumba FAYE.
In addition, Ankara Services is automatically the health manager of Leadway IARD for
contracts related to the health branch. Nevertheless, Ankara is free to contract agreements with
other players in the field of health insurance: Insurers, Brokers, Companies and even other
health managers.

Diagram 3: Organization chart of Ankara Services Côte d'Ivoire

MANAGING DIRECTOR
COUMBA FAYE

CLAIMS DIRECTOR HEAD OF TECHNOLOGY

SALES DIRECTOR AND INFORMATION CFO
CLARISSE FOFANA PRODUCTION DIRECTOR MEDICAL DIRECTOR
SAM JESUS DJEDJE COMMUNICATION JOCELYN BEUGRE EUGÈNE DOUÉ
JUNIOR KLA
LAGRANGE ANGUI

HEAD OF
HEAD OF CLAIMS CALL CENTER UNDERWRITING
2
DRIVER
1

FRONT DESK
1

Source: The Host Company

Paragraph 2: Analysis of the activity of Leadway Vie

Leadway Vie, like most life insurance companies on the Ivorian insurance market, mainly
markets two types of products, namely savings products and provident products. We will then
present all the products of this structure.
1- Savings products
These products meet a policyholder's protection and savings needs. The optional risk
component offers financial protection to the subscriber in the event of death or for any other

35
covered risk during the term of the contract. The savings component provides a means by which
subscribers can build up savings or capital during the term of the contract.

a- Presentation of savings products

There are four Leadway Vie savings products:
- Leadway Retraite Pro
This product is a retirement savings platform. It aims to provide a steady source of income after
retirement, especially for the self-employed or those who want to supplement the income from
their company-sponsored retirement savings account.
- Leadway Souklou Épargne
This is a product that gives the possibility of guaranteeing the financing of the studies of one's
children or any other person. In addition, if the insured dies, contracts a designated critical
illness or becomes disabled following an accident during the period of cover, depending on the
optional guarantees taken out, the sum insured for the risk incurred is paid.

- Leadway Elite
This is a product that gives the possibility of guaranteeing the financing of the studies of one's
children or any other person. In addition, if the insured dies, contracts a designated critical
illness or becomes disabled following an accident during the period of cover, depending on the
optional guarantees taken out, the sum insured for the risk incurred is paid.

- Djiguiya
Djiguiya is a savings product which also offers the insured the possibility of obtaining a
mortgage loan from one of Leadway Vie's partner banks. It also offers protection options in the
event of death, serious illness or Total and Permanent Disability (ITD) following an accident
during the contract.

b- Features of savings products

To be eligible for subscription to these products, certain conditions regarding age must be met.
This is because the age should be calculated as the age of the next birthday, unless explicitly
stated otherwise. Then, the minimum age for subscription is 18 years old and the maximum
age at the end of the contract is 65 years old for Death & PTD cover and 60 years old for serious
illnesses.

36
For these types of savings contracts, contract durations and premiums differ from one to
another. We thus have:
- 10 years / 10,000 FCFA for Leadway Rétraite Pro;
- 5 years / 20,000 FCFA for Leadway Souklou Education;
- 1 year / 500,000 FCFA for Leadway Elite;
- 8 years / 100,000 FCFA for Djiguiya
The maximum duration is such that the contract expires at the age at which the insured reaches
the age of 60 for contracts with Critical Illness cover and 65 for contracts with Death cover and
ITD.

c- How Leadway Vie savings products work

A savings account will be opened for each subscriber to which periodic premiums will be
allocated. At the end of the contract, the amount accumulated in the savings account is paid to
the designated person or to the subscriber. When a risk guarantee is taken out, the capital
insured for the risk and the savings constituted on the date of declaration of the claim are paid.

At the end of the contract, the balance of the savings account is paid. It could also protect the
beneficiary in the event of death, designated serious illness and Total and Permanent Disability
(ITD) following an accident, depending on the optional and additional cover taken out. In the
event of declaration of a claim relating to an optional guarantee taken out before the term or
expiry date of the contract, the insured capital chosen at the time of subscription to the contract
plus the savings made up to date is paid.

d- Mortgage
Mortgage loans are only authorized for subscribers to the Djiguiya product. Any subscriber to
the Djiguiya product can take out a loan from Leadway Vie's partner banks when the balance
of their account reaches at least 35% of the amount of the desired mortgage loan and the
contract runs for at least 3 years without a partial redemption operation and with no unpaid
premiums.
When a mortgage loan is granted to a subscriber, death insurance coverage (decreasing capital)
is taken out by the latter with Leadway Vie to cover the mortgage loan. An amendment may
be made to modify the initial duration of the Djiguiya contract and make it correspond to the
duration of the loan. The endorsement may also contain a modification of the initial premium
by reducing it to an amount which may not be less than 30,000 FCFA per month.

37
 e- Conditions required for claims settlement
Following a claim, the beneficiary must provide a list of documents in order to be able to be
compensated, which are: a notification (telephone, mail, e-mail, or via the application), the
original of your contract and its endorsements, the report of the finding of the judicial police if
the death is following a traffic accident, the death certificate of the insured, the supporting
documents of the identity of the Beneficiaries and all other documents requested by Leadway
Life.
In the event that the claim declared is a serious illness or an ITD claim following an accident,
it is necessary to provide a notification (telephone, post, e-mail or via the application), if
necessary, the medical certificate stating the state of disability with the precise cause and nature
of the disability as well as the date on which it became final, the complete medical report from
the attending physician and any other document requested by Leadway Vie.

2- Provident products
All of these products aim to cover the subscriber or the insured against a set of social risks
which include death, serious illness and ITD following an accident. As far as Leadway Vie is
concerned, we have a total of six provident products, which are: Death Borrower, Kanakassi,
Leadway Lifestyle Protection, Leadway Collective Welfare, Leadway Souklou Protection and
Leadway Queen.

a- Death Borrower
This product has two options:
- Option 1: Death Borrower (with decreasing capital)
The Decreasing Mortgage Borrower Death product is designed to cover repayable loans in the
event of the death of the borrower.
The subscriber decides the capital to be covered and the duration of the contract, which are
respectively the initial amount of the loan and the duration of the loan.
In the event of the death of the insured (the borrower) before the end of the contract, the insurer
replaces him for the payment of the capital remaining due in accordance with the amortization
table of the loan. The same benefit is paid in the event of Total and Definitive Disability
resulting from an accident.
The product also offers optional coverage in the event of Job Loss.

38
The maximum age at the end of the contract is 65 years old. Beyond this age, the bank must
refer the client to LEADWAY VIE;

- Option 2: Death Borrower (at constant capital)

The Death Borrower with growing capital product is designed to cover line of credit and more
generally non-amortizable loans in the event of the death of the borrower.
The subscriber decides the capital to be covered and the duration of the contract, which are
respectively the initial amount of the loan and the duration of the loan.
In the event of the death of the insured (the borrower) before the end of the contract, the insurer
replaces him for the payment of the amount of the loan within the limit of the sums due on the
date of death. The same benefit is paid in the event of Total and Definitive Disability resulting
from an accident.
The product also offers optional coverage in the event of Job Loss.
The maximum age at the end of the contract is 65 years old. Beyond this age, the bank must
refer the client to LEADWAY VIE.

Commissions payable for this product are generally negotiable rates, which impact premium
rates. They vary between 10% and 15% of the premium to be paid.

b- Kanakassi
Leadway Kanakassi is a life insurance policy which is designed to guarantee a benefit in kind,
and possibly in cash to the subscriber or his family in the event of the death of the latter or of
a member of his insured family (father, mother , uncle, aunt; father-in-law, mother-in-law and
children). This product also has two options:
- Option 1: Renewable annual cover. Coverage ends after one year and may be
renewed upon payment of the renewal premium to be determined.
- Option 2: Lifetime coverage of the customer. Level premiums are only paid over a
5-year period, but coverage is valid for life.
Some characteristics

- Bespoke funeral service options.

- It is coverage for the provision of in-kind funeral services to the insured.
- Additional coverage can be purchased to cover uncles, aunts, parents, in-laws and
children.

39
 - Each insured person must be covered for the provision of funeral services in kind,
according to the different categories available.
- It is possible to choose different categories of funeral services per insured person.
- For each insured person, it is possible to subscribe to additional guarantees against
cash payment, in addition to funeral services in kind. The cash benefit on each
insured person may be different, subject to underwriting limits.
- The premium depends on the age at the time of joining and is calculated as rate
times sum insured, for each member of the family.
- There is no maximum subscription age.
- The customer has the possibility of subscribing as an option to a capital to be
collected in cash in addition to the services in kind carried out by the partner of the
funeral directors. The amount in cash is left to the choice of the subscriber.
- In the event of the death of one of the insured, the free additional benefit of 5,000
CFA francs for unit refill is paid to the policyholder.
- The death benefit is not payable for claims other than accidental death occurring
within the first thirty (30) days following the effective date of the policy. If an
insured person dies accidentally during the waiting period, the sum insured will be
paid. There is no waiting period for renewal.

Categories of Services
Table 5: Category of the services of the product "KANAKASSI"

CATEGORIES SERVICES COST (FCFA)

1. Removal
Islamic 2. Treatment of the body 3. Preservation of the body 200,000
for 2 days
40
 3. body lift
4. Coffin and transfer of the body to the place of
burial Abidjan.

1. Removal
2. Treatment of the body 3. Preservation of the body
for 7 days
Bronze 3. body lift 300,000
4. Coffin worth 140,000 F
5. Transfer of the body to the Abidjan burial place.

1. Removal
2. body treatment
3. Preservation of the body for 15 days
4. body lift
Money 500,000
5. Coffin worth 250,000F
6. Transfer of the body to the place of burial Abidjan
and Suburbs (round trip) 150 Km*2.

1. Removal
2. body treatment
3. Preservation of the body for 30 days
4. body lift
Gold 1,000,000
5. Coffin worth 650,000F
6. Transfer of the body to the place of burial inside
the country (round trip) 250 km*2.

1. Removal
2. body treatment
3. Preservation of the body for 30 days
4. body lift
Platinum 5. Coffin worth 850,000 F 1,500,000
6. Transfer of the body to the place of burial inside
the country (round trip) at 500 Km*2

Source: The Host Company

c- Leadway Lifestyle Protection

Leadway LifeStyle is designed to help the insured, and their family, maintain their standard of
living, even after experiencing unfortunate events. The events that could be covered are: death,
serious illness, Total and Permanent Disability, loss of employment and medical expenses
resulting from an accident. The product also provides protection against future inflation by
providing an option to increase the face amount each year. The guarantees of this cover are:

41
Death, Serious Illness, Total and Permanent Incapacity (ITD) following an accident, Loss of
employment and medical expenses for accidents.

Guarantees

- Death benefit: If death occurs during the contract, the subscribed capital is paid
annually over the payment period for the services chosen at the start of the contract.
Principal payment term options range from one (1) to ten (10) years. The choice of
a duration of benefits of one (1) year indicates a single payment over this period.
This contract ends in the event of death;
- Serious illness (optional): If the subscriber suffers from a critical illness covered
by this contract (cancer, stroke, heart attack, kidney failure, coronary artery bypass
and coronary angioplasty), the sum insured under the critical illness at the time of
the declaration is paid. This insured capital must be less than or equal to the insured
capital of the death benefit. Serious illness does not terminate the contract;
- Permanent Total Disability (ITD) following an accident (optional):If, following
an accident, the insured becomes disabled during the course of the contract, the
capital insured for disability at the time the risk materializes is paid. This insured
capital must be less than or equal to the death benefit. The ITD does not terminate
the contract;
- Job loss (optional):If the subscriber loses his job during the period of insurance,
the benefits to be paid will be options of 25% or 50% of his monthly salary over a
period of 6 or 12 months, depending on the options chosen at the start of the
contract. The monthly benefits payable are limited to 300,000 CFA francs. Only
one payment will be authorized during the term of the contract;
- Medical expenses for accidents (optional):If, following an accident, the
subscriber is hospitalized, the medical expenses are reimbursed, subject to the
insured annual limit.

Operation

- The age should be calculated as the age at the next birthday;

- The minimum duration of the contract is one (1) year and the maximum duration is
such that the guarantee ends the year in which the insured turns 65 for death cover,
60 for critical illness and 51 for job loss;

42
 - You can choose an annual increase rate from the options of 2.5%, 5% and 7.5%;
- When this option is chosen, all options chosen will increase each year at the rate of
increase in the face amount;
- Under this product, you will receive a refund of 10% of the annual premium paid,
provided that all premiums have been paid for the first 2 or more consecutive policy
years. After the first payment, a refund is made for each year that there is no claim,
provided that the policy is up to date with its premiums;
- The minimum insured capital for Death cover is One million CFA francs (1,000,000
FCFA);
- The premiums payable are level premiums over the term of the contract. The
premium depends on the duration of the contract and the age of the insured and is
calculated on the basis of the insured capital.

Services
LEADWAY VIE will pay for the services subject to the transmission of the following
documents:
In the event of Death:
- the original of your contract and its amendments;
- the report of the finding of the judicial police if the death is following a traffic
accident;
- the death certificate of the insured;
- the supporting documents of the identity of the Beneficiaries;

In the event of Total and Permanent Disability and Serious Illness:

- where applicable, the medical certificate confirming the state of disability,
specifying the cause and nature of the disability as well as the date on which it
became final;
- the full medical report from the attending physician;

In the event of Hospitalization following an accident (Medical Expenses following an

accident):
- Medical report containing the exact cause of hospitalization;

In the event of Job Loss:

43
 - Dismissal letter from the insured;
- Payment for benefits is made at the head office of LEADWAY VIE, within thirty
(30) days of the delivery of supporting documents in the event of Death,
Hospitalization Following an Accident, Loss of Employment, 60 days in the event
of of Serious Illness, and 90 days in the event of Total and Permanent Disability.

d- Leadway Group Welfare

It is an insurance contract taken out by a company or an organization for the benefit of its
members. It is intended to cover the latter against a set of social risks which include death (all
causes), serious illness or Permanent and Total Disability (PTD) following an accident.
Guarantees

- Death benefit: In the event of death occurring during the contract, an insured
capital is paid subject to the terms and conditions of the contract. This service
terminates the contract;
- Serious illness (optional):the sum insured for critical illness (subject to the terms
of the contract) is paid when the subscriber is diagnosed with it. The basic contract
does not end after payment of the benefit of this guarantee;
- Permanent Total Disability (PTD) following an accident: This is the benefit to
be paid if the insured, following an accident, becomes permanently disabled. The
capital insured for disability is equal to the death capital.

Functioning

- The age considered for the evaluation is the age at the next birthday;
- The duration of the contract is one (1) year renewable annually;
- Riders are permitted prior to the policy maturity date to allow for the addition and
removal of members. Where there is an endorsement, the net premium due at the
end of the policy term is calculated and reported based on the premium rate agreed
at the start of the policy year;
- The beneficiary(ies) receive(s) the benefits in the event of the death of the insured.
In the event of the death of the Beneficiary or when the insured has no beneficiary
mentioned in the Policy, the benefits due will be paid to the estate of the insured.

44
Services
LEADWAY VIE will pay for the services subject to the transmission of the following
documents:
In the event of Death:
- A statement email from the underwriter or broker;
- the death certificate of the insured indicating the cause of death;
- the Beneficiary's identity documents;

In the event of Total and Permanent Disability and Serious Illness:

- A statement email from the underwriter or broker;
- Medical diagnosis of the employee's condition, by a physician approved by both
parties
The legal maximum period for performance of the services is fifteen (15) days from the
delivery of the supporting documents.

e- Leadway Souklou Protection

Leadway Souklou Protection is a life insurance contract designed to guarantee the continuity
of the child's education if the insured risks arise with the parent, guardian or sponsor of the
child's education. The contract covers the child's tuition fees for the current school years from
the moment the sponsor / parent / guardian is unable to do so following death, serious illness
(optional) or Total and Definitive Disability resulting from an accident (optional).

Guarantees
In the event of death occurring during the contract, the benefit to be paid will be one of the two
following benefit payment options: a constant benefit which materializes as the single payment
of the insured capital if one of the insured risks occurs during the duration of the contract and
an annual benefit payment for the current and remaining school years.
Then, in the case of ITD, the capital insured for disability is equal to the death capital.
Finally, in the case of a serious illness, the capital insured for the serious illness is also equal
to the death capital. The payment of a benefit on an optional risk does not terminate the contract

Operation

- The age considered for the evaluation is the age at the next birthday;

45
 - The minimum duration of the contract is one (1) year and the maximum duration is
such that the age of expiry of the contract must not exceed 65 years for a guarantee
death and ITD following an accident, and 60 years for a cover serious diseases ;
- Riders (changes) to face amount are permitted on policy anniversaries, to reflect
current tuition realities;
- With one contract, you could cover several children of different grade levels. Under
this product, you will receive a refund of 10% of the annual premium paid, provided
that all premiums have been paid for the first 2 or more consecutive years of
insurance. After the first payment, a refund is made for each claim-free year,
provided the policy is up to date with its premiums.

Services
LEADWAY VIE will pay for the services subject to the transmission of the following
documents:
In the event of Death:

- the original of your contract and its amendments;

- the report of the finding of the judicial police if the death is following a traffic
accident;
- the death certificate of the insured;
- the supporting documents of the identity of the Beneficiaries;
-

In the event of Total and Permanent Disability and Serious Illness:

- where applicable, the medical certificate confirming the state of disability,

specifying the cause and nature of the disability as well as the date on which it
became final;
- the full medical report from the attending physician.

Paragraph 3: Definitions of the roles of each actor in the implementation of the product

The health product for retirees with deferred funding requires the involvement of three players:
Leadway Vie, Leadway IARD and Ankara Services CIV. The process of this product begins
46
with the subscription to a savings which will later be paid back to the insured in the form of
annual health cover, until the end of his days. To do this, it is important to clearly define the
commitments and limits of each actor mentioned above.

1- Leadway Vie
Leadway Vie is the main player in this product. He will be responsible for signing the contracts
for this product with the plan that requested us. Subscription to this product will involve the
periodic payment of premiums (quarterly contributions). These premiums will feed the
portfolio fund of this plan and generate interest according to the defined rate. At the end of
each year, Leadway Vie will transfer an “Annual Bonus” to Leadway IARD on behalf of the
employees of the mutual who will be retiring. Leadway Vie will therefore have the role of
Subscriber for the mutual.

2- Leadway IARD
Leadway IARD collects the premiums for the health product for retirees of the mutual
insurance company and therefore will provide the various beneficiaries with the relevant
contractual documents. He is required to pay the claims management commissions to Ankara
Services.

3- Ankara Services
In its capacity as health manager, Ankara Services manages reimbursement requests for care
received by insured persons (retirees) with the providers defined in the Ankara care network.
In return, Ankara will receive the commissions and funds allocated to the settlement of claims
by Leadway IARD.

Section 2: Presentation of Life Insurance on the Ivorian market

Paragraph 1: Definition of Insurance in the CIMA zone

1- The CIMA area

The Cima Code is the result of the Cima treaty signed on July 10, 1992 which establishes an
Inter-African Conference of Insurance Markets. The code itself regulates insurance operations
and insurance companies replacing the old French legislation of 1930. CIMA groups together

47
14 countries: Benin, Burkina Faso, Côte d'Ivoire, Guinea Bissau, Mali, Niger, Senegal, Togo,
Cameroon, Central African Republic, Congo, Gabon, Equatorial Guinea, Chad.

The treaty establishing the CIMA makes, among other things, reference to the objectives of the
Conference, to the new market legislation and to the bodies and powers put in place.

The objectives assigned to the CIMA are in particular:

− improve risk coverage by adapting them to African realities;

− to encourage the retention of cases at national and regional level;
− promote local investment of the provisions generated;
− to create common structures in order to promote the development of insurance companies,
to promote the creation of a broader and integrated market in all the member countries and to
set up new financial instruments;
− to pursue the policy of harmonization and unification of legislative and regulatory provisions.
In order to meet these objectives, the Conference has adopted a single insurance legislation:
this is the Insurance Code of the CIMA Member States.

Finally, still with a view to ensuring the full achievement of the objectives of the Treaty, three
bodies were reorganized or created around the CIMA:
− the Council of Ministers (directing body of the CIMA which ensures the achievement of the
objectives of the Treaty);
− the Regional Insurance Control Commission (CRCA, CIMA's regulatory body which
monitors companies, provides general supervision and contributes to the organization of
national markets);
− the General Secretariat (a body that prepares, executes and monitors the work of the Council
of Ministers and the CRCA).

Since 1995, the numerous measures taken by the CRCA (warnings, reprimands, placing
under permanent surveillance, suspensions of managers, withdrawals of approvals, etc.) and
the Council of Ministers (regular amendments to the CIMA Code, including in particular
capital increases minimum social security) have contributed to the development of the
turnover of insurers and to a cleaning up of the market.

48
 2- Definition of Insurance

Insurance is a very complex notion that changes significantly depending on the context. In
other words, insurance is a contract between insured and insurer. The insurance contract is a
contract covered by articles 1963 and following of the Ivorian Civil Code. It is an agreement
in which upon payment of a sum of money (premium), a natural or legal person (the insured)
obtains from another (insurer) itself bound by a similar contract to another person (reinsurer)
the payment to oneself or to a third party of a certain sum (compensation) when an event called
risk occurs. When the risk materializes, we say in insurance that there is a claim.

3- Generalities

a- The insurability of risks

The insurance contract is random. This is why some risks are insurable and others are not. The
conditions allowing the insurability of a thing are the hazard, that is to say the unpredictability
of a harmful event as such or of one of its characteristics (example: the date of death), the
independence of the will of the insured (example: the accident), the lawful nature of the event
(example: the impossibility of insuring the consequences of a criminal conviction or fines).
This implies, among other things, that known past events are uninsurable (loss already
incurred). Consequently, in principle, it is possible to take out insurance for any event relating
to the ownership of movable or immovable property.

b- Characteristics of an insurance contract

Obligations arising from an insurance contract

The insurance contract establishes most of the rights and obligations of each party (insured and
insurer). It establishes the conditions under which the service will be rendered. It usually
mentions:

- the premium that the insured undertakes to pay;

- the benefit that the insurer will provide;
- the uncertain event (the risk);
- insurance interest (expressed negatively): the insured or the designated beneficiary
must not have any interest in the occurrence of the risk.

49
Documents confirming the conclusion of the insurance contract

In insurance, whatever the branch, the will of the parties is sufficient to create the contract.
However, the documents evidencing the insurance contract are: the insurance policy, the cover
note and the endorsement.

The insurance policy is the document that records the signature of the insurance contract. It
bears the signature of the insurer and the insured; it summarizes the conditions of the
agreement.

The cover note is a document that reconciles the insurer's desire not to take unnecessary risks
and the insured's need to quickly benefit from coverage.

At the end of article 7 paragraph 2 of the CIMA Code, “any addition or modification to the
initial insurance contract must be recorded by an endorsement signed by the parties. The
endorsement is one with the policy and obeys the same rules of form.

- The subscription of an insurance contract

When subscribing to the contract, the insurer and the insured agree: on an event or a list of
events, included in the insurance policy and guaranteed by the insurer and on a premium paid
by the insured to the insurer.

Before subscription, the insurance applicant, future insured, completes a questionnaire aimed
at informing the insurance company of their risk. From this document, the insurer can calculate
the insurance premium. This statistical calculation essentially takes into account the probability
of occurrence of the risk and the cost of claims.

The insurance contract is a contract of good faith. The insured is supposed to inform the insurer
accurately and completely in response to his questions. False declarations made by the insured
may lead to the nullity of the contract.

- The end of the insurance contract

The insured and the insurer can terminate the contract at each expiry date. Insurance contracts
are generally automatically renewable. The insurance code also provides for possible

50
termination for the insurer after each claim. In the event of disappearance of the insured risk,
for example in the event of death for an insurance contract on a person, the contract naturally
ends. However, during the term of the insurance contract, it is possible that the contracting
parties agree to certain modifications: we speak of modifications to the insurance contract (for
example the addition of new guarantees to the initial contract). Insurance is a sector which
therefore has its own specificities which should be explained.

c- Insurance Specifications

Economic functioning of insurance

The purpose of the insurance contract is to transfer risk:

The insured cedes a risk, by definition random, to the insurance company. When the contract
provides for a deductible, the insured retains part of the risk at his expense. The insurance
company accepts the risk in exchange for the premium, whether guarantees:

- Non Life in the event of damage or liability (fire, accidents, various risks) or;

- Life in case of compensation related to human life.

The insurance mechanism does not modify the probability of occurrence of the risk, except
"moral hazard", that is to say anticipation of loss by the policyholder leading to a bias in the
selection of risks. The contract organizes the transfer of the guarantee and the risk of an insured,
to one or more other sets of insured constituting a mutuality: this is the pooling of risks. The
subscriber of the contract, who pays the premium or contribution (in the case of a mutual
insurance company) may be different from the insured. The subscriber is the person who
presents himself to contract the policy with the insurer, he can subscribe either for his own
person (in this airlock he is the insured) or on behalf of a beneficiary then the subscriber is a
person distinct from the insured.

In these two cases, the subscriber remains responsible for paying the premium or contribution
vis-à-vis the insurer because he is contractually committed to it. This provision is provided for
in Article 5 of the CIMA Code entitled Mandate - Insurance on behalf.

51
The insurance company carries out, thanks to the subscription of many similar risks, a pooling
of risks between the insured. This statistical control of risk enables the insurer to reduce the
total volatility of its risks. Insurers use the law of large numbers which allows them to know
approximately the amount of future claims.

The technical operation of insurance

From a technical and economic point of view, insurance is distinguished by three principles:

- The inversion of the production cycle:

The companies begin by collecting their contributions from the policyholders' mutual fund
before providing (more or less many years later depending on the branch of activity and the
nature of the claims) their benefits to the insured parties.

- Major risk taking on liabilities

With a view to the subsequent settlement of claims, insurance companies constitute technical
provisions, representative of the risks (frequency, evolution of average costs, serious claims,
various types of sector inflation) transferred to their liabilities.

- The negative transformation

To cover their technical provisions, the companies invest in investments that are mainly liquid
and generally low risk, which is, to a certain extent, imposed by the regulations. This is the
opposite situation to that of banks which finance more or less long-term loans through demand
deposits. As a result, insurance companies present an accounting working capital.

d- Types of insurance

The most common types of insurance contracts are life insurance contracts and property and
casualty insurance contracts (Fire, Accident and Miscellaneous Risks). A distinction is made
between Personal Insurance (AP) contracts and property and liability insurance contracts.
52
 Personal insurance corresponds to life insurance supplemented with bodily injury insurance
(Health, Disability, Death from any cause). Property and liability insurance corresponds to Non
Life, excluding bodily injury insurance. Sometimes insurance insures lotteries and games, so
that unlikely and big wins are possible.

Table 6: Life insurance and other categories of insurance

DAMAGE INSURANCE PERSONAL INSURANCE

OBJECT Wealth insurance Personal insurance of the insured
Liability Bodily damage
Property insurance
insurance (insurance for
(insurance of the Illness Medical Life
SUBDIVISION Bodily
property consequences costs/Pharmaceutic insurance
belonging to the of the accidents
al costs
insured) insured's
liability)
Compensativ
PRINCIPLE Compensative flat rate Compensative flat rate
e
MANAGEME Distributio Capitalizati
Distribution Distribution Distribution
NT n on

Source:http://fanaf.org/article_ressources/file/20070826_seminaire_fonctionnement_techniq
ue_actuarial_assurance-vie_Bamako.pdf

4- Insurance in Côte d’Ivoire

The activities of Ivorian insurance companies are governed by the insurance code of the
member states of the Inter-African Conference on Insurance Markets (CIMA) and are
supervised by the Insurance Department, which depends on the Ministry of Economy and
Finance. Insurance companies in Côte d'Ivoire operate mainly through insurance
53
intermediaries, which include more than 200 insurance agents and more than 70 brokers. They
are the ones who bring business to them for remuneration in the form of commissions.

Insurance in Côte d'Ivoire covers two branches: the IARD branch (non-life) and the life branch.

The property and casualty branch (fire, accidents and miscellaneous risks) allows Ivorian
insurance companies to achieve nearly 60% of their turnover. It is she who allows the insurance
market to be strongly boosted in Côte d'Ivoire. The property and casualty branch covers bodily
injury and illness, automobile insurance which is compulsory, fire and other damage to
property, transport, general civil liability and other miscellaneous risks.
a- The Association of Insurance Companies of Côte d'Ivoire

Created on December 21, 1956 under the name of Grouping of Insurers, the ASA-CI
(Association of Insurance Companies of Côte d'Ivoire), in its current version, has existed since
June 2, 1966 and called "Committee of insurers of Côte d'Ivoire", and later "Association of
insurance companies operating in Côte d'Ivoire", To date, the ASA-CI is made up of 42
member companies:
ii- 22 companies operating in the “Non-Life” branch;
iii- 11 companies operating in the “Life” branch;
iv- 07 reinsurance companies;
v- National Social Insurance Fund (CNPS);
vi- Automobile Guarantee Fund (FGA)
ASA-CI is a member of the General Confederation of Enterprises of Côte d'Ivoire.

b- The main missions of the ASACI

The missions of the ASACI are the following:
- Represent the interests of the profession with its interlocutors, public and private,
national and international and in all circumstances where joint action is deemed
necessary.
- Being a consultation tool with its various partners: consumers, media, other sectors
of activity... As such, it also plays an interface role between member companies and
technical or social organizations organized and managed on a collective basis .
- Joint study of technical, financial and legal problems: for, among other things:
drawing up proposals for the development or revision of pricing, proposing to

54
 member companies measures to facilitate discussion and the solution of all
questions or observations that could arise, etc., which implies carrying out studies
at the level of the whole market. The ASA-CI compiles retrospective and
prospective insurance statistics.
- Inform the public, in particular through its website www.asaci.net and through
various publications such as the review providing for it.
- Promote insurance and reinsurance in Côte d’Ivoire

5- Life Insurance in the CIMA zone

a- Definitions

Life insurance is a bilateral contract which gives rise to a random scenario of financial flows
where the insurer on the one hand undertakes to pay the beneficiary designated by the
contracting party sums in the event of the death of the insured person (physical or morality) or
its survival at a given time and the latter also undertakes to pay bonuses according to a very
specific schedule. In this definition there are four parts to be distinguished:

- The insurer

It is the legal entity that undertakes to bear the financial consequences of the realization of the
risk. It is a commercial enterprise approved by the CRCA (Regional Insurance Control
Commission), whose nature of operations and form of legal constitution are defined in articles
300 and 301 of the CIMA Code.

- The contractor (or Subscriber)

This is the legal or natural person who undertakes legally towards the insurer, in particular for
the payment of the premiums provided for in the contract. He is the signatory of the contract
and it is up to him to designate the beneficiaries of the insurer's service.

- The insured

It is the natural person whose death or survival triggers the payment by the insurer of the
benefits provided for in the contract. He is the main element of the contract in the sense that it

55
is his age and state of health that allows the insurer to set the amount of the premium to be paid
by the subscriber.

- The beneficiary

It is the natural or legal person who will receive the services provided for in the contract in the
event of the risk materializing. The choice of beneficiary is a personal right of the subscriber.
However, in certain cases, the subscriber may authorize the insured to designate the beneficiary
himself (case of group contracts). With regard to life insurance contracts in the event of death,
the insured must give his consent in writing to the designation of the beneficiary.

b- Features of Life Insurance

- The flat-rate principle of the insured capital

The contracting parties already know at the start of the contract the sum insured, which is set
arbitrarily by the subscriber. The amount of any claim is therefore known and fixed from the
outset.

- The absence of the notion of underinsurance

In the event of a claim, an insurer can never limit the payment of the sum designated in the
contract for any reason whatsoever.

- The absence of the notion of accumulation of insurance

The benefits of a personal insurance contract can be combined with an indemnity linked to the
liability of a third party. Thus, an insurer can never refuse to pay the sums provided for in the
contract on the pretext that other contracts are provided for the same risk. Similarly, an insured
or a beneficiary may act against a responsible third party in the event that the event that has
occurred (accident, death, etc.) engages the responsibility of a third party.

- The insurer's lack of recourse against the liable third party

56
The insurer, after payment to the insured of the contractual indemnities within the framework
of a life contract, cannot turn against the third party responsible for the damage in order to
recover the sums paid, because the guarantee was acquired by the insured regardless of i.e. the
event that allowed the risk to materialize.

- The non-compulsory nature of the payment of premiums

In life insurance the payment of the premium is not compulsory. The subscriber can stop paying
his premiums at any time without having to follow any procedure vis-à-vis the insurer. The
latter cannot take any action against the contracting party to recover the premiums.

- The life insurance management technique is capitalization

The premiums paid by the insured are capitalized on the basis of an interest rate taking into
account the possibility of survival or death of the insured. This technique for managing life
insurance operations is opposed to the pay-as-you-go management of property and casualty
operations or pension funds.

Paragraph 2: Analysis of life insurance business in CI

1- Life insurance in the event of death

There are three (3) forms which are Term Death, Survival Insurance and Whole Life Insurance:

a- The Term Life Insurance

It guarantees the payment of a death benefit if the insured dies before a specified date. If the
insured is still alive at maturity, the insurer keeps the premiums and is released from any
obligation. It is a pure risk insurance which is done with lost funds. It can rest on one or more
heads. And the benefits are payable in whole or in part according to the terms of the contract
upon the death of the first insured.

b- Survival Insurance

This type of contract is subject to a condition of survival. Indeed, the insurer undertakes to pay
a capital or an annuity in return for premiums paid throughout the life of the insured to a
beneficiary provided that he survives the expiry date. If the death of the beneficiary occurs
before that of the insured, the insurer is released from any obligation. The size of the premiums

57
depends on the age of the insured and the beneficiary. They are all the more important as the
insured is all the younger and the beneficiary older.

c- Whole Life Insurance

This is aimed at the payment of the capital fixed in the contract at the time of the death of the
insured, regardless of when it occurs. It is no longer a question of a risk with lost funds but of
the constitution of certain savings. The insurer knows that he will intervene to perform the
promised service, the only hazard lies in the time of the occurrence of death. Bonuses can be
lifelong, temporary. They can be unique. The risk can be on one or more heads, the guaranteed
capital being payable once on the first death. There is a possibility of providing options.

There are deferred whole life insurances in which the insurer's service does not become due
after a date previously fixed in the contract. This formula has the advantage of allowing lower
premiums since the insurer is released from all obligations if the insured dies before the date.
It includes counter-insurance that allows the reimbursement of premiums paid if death occurs
before the deferral date. It is often used to benefit the heirs, facilitate a preferential allocation
or allow the heirs to dispose of the transfer costs.

By taking out insurance in the event of death, the subscriber exposes himself to paying
premiums in vain, the obligation of the insurance never becoming enforceable. To avoid this
inconvenience, it is possible to provide a counter-insurance which will oblige the insurer to
reimburse the premiums.

2- Life insurance in case of life

They are the opposite of insurance in the event of death. The purpose of life insurance is to
build up a capital or an annuity for a fixed period. The insurer undertakes in return for a periodic
or single premium to pay the sum of money provided for in the contract if the insured is still
alive. The risk for the insurer is the survival of the insured and for the insured his premature
death. There are three (3) main forms with counter-insurance:

a- Deferred capital insurance

The capital is paid on the due date, ie the insurer defers the payment of the capital for a certain
number of years. The risk taken on can be based on one head or several heads. If the premium

58
is periodic, it may be stipulated payable until the date of the deferral or until an earlier date. In
the event of the death of the insured, the premiums cease to be due, the insurer is released from
all obligations and retains the premiums collected except in the event of counter-insurance.

b- Annuity insurance in the event of life

This insurance allows you to build up an annuity (periodic payments) rather than a lump sum
(single payment). The subscriber undertakes to pay premiums, the terms of payment of which
will vary according to the size of the deferred payment. If the deferred period is less than two
(2) years, the premium is in principle single. Conversely, if it is a long-term contract, the
premiums are periodic. Benefits only begin to be paid from a previously agreed date and are
only due if the insured is alive at the fixed term. The annuity most often is for life but it can
also be temporary (retirement).

c- Immediate annuity insurance

With this type of product, in return for capital paid at the time of subscription, the insurer
immediately pays the beneficiary a periodic annuity provided that the insured is alive at each
of the contract's maturities. Most often, the beneficiary and the insured are the same person,
but nothing prevents them from being different people. The immediate annuity can be
temporary or lifelong. The premature death of the insured releases the insurer from any
obligation with regard to the insured. This is the case if the insured dies before the deferral.
The savings are definitively lost for the subscriber, which is why a counter-insurance for a
specific premium can be provided. If the insured dies before the deferred date and has taken
care to take out counter-insurance,

d- Mixed insurance

They combine life and death insurance. They make it possible to guarantee the risk of survival
and death through a single contract. It is about an alternative insurance in which will be put in
play either the guarantee in the event of life, or the guarantee in the event of death. There are
several forms:

59
 e- regular mixed

It is a temporary death insurance plus deferred capital insurance. The insurer undertakes to pay
the beneficiary compensation, either on the date fixed in the contract if the insured is alive, or
on the death of the insured if it occurs before this deadline. The insurance therefore covers two
contradictory risks, only one of which will occur during the insured period. It is on one or more
heads (spouses). It may be accompanied by a double effect clause. The premium can be one-
time or periodic. The mixed, in particular, corresponds to people who want to build up savings
while carrying out a provident act in favor of their families.

f- Fixed term insurance

Here, the insurer undertakes to pay a capital on a fixed date whether the insured is alive or not
at that time. If the insured is alive, he receives the benefits provided. If he dies before term, the
beneficiary receives benefits only on the date stipulated in the contract. The payment of
premiums is necessarily periodic.

There are many other forms and variants of endowment insurance.

60
 Chapter 4: Pricing Model for Deferred Health Coverage for Retirees

This chapter will deal with the description of the product pricing process and its application.
We are going to analyze the data and highlight their relevance in order to build our model.
Then, we will present the results of the application to our study population.
Section 1: Building the model
In this first section, we will define and discuss the steps that led us to the development of our
pricing model. For reasons of confidentiality, we have intentionally omitted the identity of the
mutual insurance company as well as the names of the individuals on whom these analyzes
relate. For the rest of this study, we will call this mutual as follows: “Mutuelle X”.

Paragraph 1: Descriptive analysis of the data

Descriptive statistics are the basis of all data analysis. Indeed, before deepening the analysis in
detail, we must begin with the overall description using these statistics.
They are used to analyze and describe data to obtain a final rendering. These are simple
mathematical calculations that allow us to identify the level of reliability of the data we have
collected in order to ensure that we obtain adequate results at the end of our study. From these
figures, graphs come in addition to support the statistical analysis.
1- The portfolio of the mutual

For our study, we used a database comprising the following variables: "Last and First Names",
"Category", "Job", "Direction", "Department", "Date of Birth", "Effective Date of Function to
the Public”, “Effective Date of Function at Mutual X”, “Function”, “Sex”, “Date of
Assignment”, “Marital Status”, “State of Health” and “Position”.

Nom et Prénoms Catég Emploi Direction Service D_NAIS D_EFP D_EDGI Fonction Sexe D_AFFECT Situation mat Etat de santé Position
E1 C1 ADJOINT ADMINISTRATIF DRAN V CAB/DR 19/10/64 08/10/86 15/03/02 AGENT D'ASSIETTE M 04/07/19 ACTIF
E2 A3 ATTACHE DE DIRECTION DRAN IV SAID YOPOUG II 14/10/78 23/02/09 23/12/13 SECRETAIRE F 26/10/18 ACTIF
E3 A3 INSPECTEUR DES IMPOTS DR ABENGOUR REC DOMAINE 07/03/74 10/02/03 21/01/03 RECEVEUR M 14/10/11 ACTIF
E4 A4 ADM SCES FINANC:IMPOTS DERAR SD ANALYSE RISQUE 31/05/80 08/03/06 09/11/06 CHEF DE BRIGADE M 06/02/18 ACTIF
E5 C1 ADJOINT ADMINISTRATIF DRAN III CAB/DR 05/01/80 31/07/09 19/11/12 AGENT D'ASSIETTE F 24/07/19 ACTIF
E6 A3 ATTACHE ADMINISTRATIF DR SAN-PEDRO CAB/DR 19/12/74 09/04/18 AGENT D'ASSIETTE M 09/04/18 ACTIF
E7 A3 INSPECTEUR DU TRESOR RPI AS I RPI AS I 09/07/18 FONDE DE POUVOIRS F 09/07/18 ACTIF
E8 A3 ATTACHE DES FINANCES RPI SAN-PEDRO RPI SAN-PEDRO 09/12/67 31/03/05 23/09/05 CHEF DE SERVICE M 23/09/05 ACTIF
E9 B3 TECHN SUP INFORMATIQUE DI SDOM 11/10/19 INFORMATICIEN F 11/10/19 ACTIF
E10 A4 ADM SCES FINANC:IMPOTS DRAN I SAID 2 PLTX III 12/12/77 30/07/08 30/07/08 AGENT D'ASSIETTE F 27/08/14 ACTIF
E11 A6 ADM EN CHEF SCES F:IMPOTS DRAN III CDI ADJAME 3&WILL 26/06/66 02/04/98 02/04/98 CHEF DE CDI F 19/12/19 ACTIF
E12 A5 ADM PRINCIP SCES F:IMPOTS DR DABOU CPFH DABOU 07/08/57 1985 1988 CONSERVATEUR F 04/07/19 mariée ACTIF
E13 A3 INSPECTEUR DES IMPOTS DRAN V SAIF YOPOUG III 04/12/88 03/11/14 17/06/13 AGENT D'ASSIETTE F 24/07/19 ACTIF
E14 A3 ATTACHE DE DIRECTION DRAN I RIF COCODY 13/12/77 05/05/08 12/06/12 SECRETAIRE F 12/06/12 ACTIF

Photo1: Presentation of the pension plan portfolio

Source: The Student

61
In the interest of our study, we will retain the most essential variables: “Category”, “Date of
Birth” and “Position”. The other variables have no impact on our modeling. We will therefore
process this data:
2- Database layout
To do this, we remove columns that are not essential to our study. Then, we complete the base
with variables thanks to the basic information which are: “Age of the employee”, “Number of
years before retirement” and “Eligible”.
- The names have been replaced by abbreviations consisting of the letter "E" and the
numbers 1 to 5232.
- The number of years before retirement is determined from the date of birth and the
age limit for retirement. This age limit varies by category. Indeed, arbitrarily, we
have decided to assign the age of 65 as the retirement age limit for category “A”
employees.
- Eligibility is based on the individual's age and status, listed in the “Position”
column. Indeed, we have agreed on a minimum contribution period of three (2)
years in order to be able to benefit from its advantages. In addition, the value of the
variable must be equal to "Active", which means that the employee in question is
indeed in good standing according to the requirements of mutual X. Thus, this leads
us to filter our population by y withdrawing individuals whose age exceeds the
maximum age to subscribe to this plan.

3- Adjustment of certain variables and Supplements

We observe a set of irregularities in the database at the level of the “Date of Birth” column.
Indeed, we count 335 rows that lack value in this column. We harmonize the date of birth
variable by arbitrarily choosing a date of birth for these 335 employees. This choice is not made
randomly. We need to determine the average age of the database without the failing rows. This
calculation gives us an average age of 44.5. We therefore retain an average age of 45 for this
population of 5232 minus the 335 individuals with an absent date of birth. Therefore, our
arbitrary age is 45. Thus, we avoid biasing the results of our study by keeping the same average
age for the entire population.

62
 Nom et Prénoms Catégorie Date de Naissance Position Age de l'employé Nbr d'années avant la retraite Éligible
E1 C 19/10/64 ACTIF 57 3 TRUE
E2 A 14/10/78 ACTIF 43 22 TRUE
E3 A 07/03/74 ACTIF 47 18 TRUE
E4 A 31/05/80 ACTIF 41 24 TRUE
E5 C 05/01/80 ACTIF 41 19 TRUE
E6 A 1976 ACTIF 45 20 TRUE
E7 A 1976 ACTIF 45 20 TRUE
E8 A 09/12/67 ACTIF 54 11 TRUE
E9 B 1976 ACTIF 45 15 TRUE
E10 A 12/12/77 ACTIF 44 21 TRUE
E11 A 26/06/66 ACTIF 55 10 TRUE
E12 A 07/08/57 ACTIF 64 1 FALSE
E13 A 04/12/88 ACTIF 33 32 TRUE
E14 A 13/12/77 ACTIF 44 21 TRUE

Photo2: Addition of additional variables to the database

Source: The Student

- In the image above, we can notice cells in rows “E6”, “E7” and “E8” marked with
yellow. These cells represent an example of rows completed with arbitrary birth
dates in such a way as to respect the initial distribution of the population.
- Row "E12" is an example of individuals not eligible for this modeling because they
are too old, i.e. the value of the variable "Number of years before retirement" is less
than 3 years. To be clear, his category is “A”, which means that the maximum age
to retire is 65 years old. This individual is 64 years old and therefore cannot
contribute for a minimum of two years before retiring.

4- Market health products

During our research, we managed to bring together the health products of 7 insurance
companies which will subsequently be referred to by the letters A, B, C, D, E, F and G. We
will use these products in order to set up a product adapted to our portfolio of future retirees. It
will be for us to make a comparison of each guarantee with the ceiling associated with it and
to determine an average offer while respecting the expectations of mutual X: a coverage rate
of 80% and a ceiling per family. of 10 million FCFA.
a- Company A
Company A offers 4 products, 3 of which have a coverage rate of 80% and one with a rate of
100%. The guarantee ceilings per family range from 2,500,000 to 20,000,000 FCFA.

63
Compagnie A

Produit Option 1 Option 2 Option 3 Option 4

Garanties Taux Plafond/an Taux Plafond/an Taux Plafond/an Taux Plafond/an

Consultation Généraliste 80% Frais réels 80% Frais réels 80% Frais réels 100% Frais réels
Consultation Spécialiste 80% Frais réels 80% Frais réels 80% Frais réels 100% Frais réels
Pharmacie 80% 200.000 F 80% 300.000 F 80% Frais réels 100% Frais réels
Frais liés au VIH / SIDA
Analyses médicales 80% 150.000 F 80% 300.000 F 80% Frais réels 100% Frais réels
Imagerie médicale 80% 150.000 F 80% 300.000 F 80% Frais réels 100% Frais réels
Examens et Petits soins 80% 150.000 F 80% 250.000 F 80% Frais réels 100% Frais réels
Hospitalisation Médicale 80% 80% 80% Frais réels 100% Frais réels
600.000 F / an 1.200.000 F / an
Hospitalisation Chirurgicale 80% 80% 80% Frais réels 100% Frais réels
Chambre en Hospitalisation 80% 15.000 F 80% 20.000 F 80% 30.000 F 80% 40.000 F
Accouchement simple 80% 150.000 F 80% 200.000 F 80% 250.000 F 100% 300.000 F
Accouchement gémellaire 80% 200.000 F 80% 250.000 F 80% 350.000 F 100% 400.000 F
Accouchement par césarienne 80% 250.000 F 80% 350.000 F 80% 450.000 F 100% 650.000 F
Frais pré et post natal 80% 100.000 F 80% 180.000 F 80% Frais réels 100% Frais réels
Soins dentaires 80% 70.000 F 80% 90.000 F 80% 120.000 F 100% 140.000 F
Prothèses dentaires non garantit 80% 120.000 F 80% 180.000 F 100% 250.000 F
Kinésithérapie non garantit 80% 100.000 F 80% 150.000 F 100% 200.000 F
Optique (adulte) (2ans) 80% 60.000 F 80% 70.000 F 80% 80.000 F 100% 120.000 F
Optique (enfant) (2ans) 80% 40.000 F 80% 50.000 F 80% 60.000 F 100% 100.000 F
Transport ambulancier 80% 20.000 F 80% 20.000 F 80% 30.000 F 80% 40.000 F
Complément d'avis médical non garantit non garantit non garantit non garantit
Capital assistance funéraire non garantit non garantit non garantit non garantit
Plafond de dépenses annuelles par assuré 1.500.000 F 2.500.000 F 6.000.000 F 10.000.000 F
Plafond de dépenses annuelles par famille 2.500.000 F 5.000.000 F 12.000.000 F 20.000.000 F

Réseau de soins ECO ECO PREMIUM PREMIUM

Classification produit 80% 80% 80% 100%

Délais de carence soins courants 1 mois 1 mois 1 mois 1 mois

Délais de carence lunetterie 6 mois 6 mois 6 mois 6 mois
Délais de carence soins dentaires 3 mois 3 mois 3 mois 3 mois
Délais de carence prothèses 6 mois 6 mois 6 mois 6 mois
Délais de carence maternité 9 mois 9 mois 9 mois 9 mois
Délais de carence affections chroniques 12 mois 12 mois 12 mois 12 mois

PRIMES TTC
PRIX PAR PERSONNE 111 950 219 600 428 160 595 000
PRIX PAR FAMILLE 332 220 667 630 996 800 1 330 800
PRIX PAR ENFANT SUPPLEMENTAIRE 45 360 92 880 189 000 232 200

Photo3: Presentation of the products of the company "A"

Source: The Student

b- Company B
Company B offers 3 products, each with a coverage rate of 80%, 90% and 100%. The guarantee
ceilings per family vary between 2,500,000 and 10,000,000 FCFA.

64
Compagnie B

Produit Option 1 Option 2 Option 3

Garanties Taux Plafond/an Taux Plafond/an Taux Plafond/an

Consultation Généraliste 80% 200.000 F 90% 500.000 F 100% Frais réels
Consultation Spécialiste 80% 200.000 F 90% 500.000 F 100% Frais réels
Pharmacie 80% 120.000 F 80% 300.000 F 100% Frais réels
Frais liés au VIH / SIDA
Analyses médicales 80% 100.000 F 90% 250.000 F 100% Frais réels
Imagerie médicale 80% 100.000 F 90% 400.000 F 100% Frais réels
Examens et Petits soins 80% selon catégorie 90% selon catégorie 100% Frais réels
Hospitalisation Médicale 80% 250.000 F / cas, 100% 100% Frais réels
1.000.000 F / an
Hospitalisation Chirurgicale 80% max 3 fois / an 100% 100% Frais réels
Chambre en Hospitalisation 80% 20.000 F 100% 30.000 F 100% 50.000 F
Accouchement simple 80% 150.000 F 100% 300.000 F 100% 450.000 F
Accouchement gémellaire 80% 200.000 F 100% 350.000 F 100% 500.000 F
Accouchement par césarienne 80% 300.000 F 100% 400.000 F 100% 550.000 F
Frais pré et post natal 80% 150.000 F 100% 300.000 F 100% 350.000 F
Soins dentaires 80% 90% 100%
100.000 F 200.000 F 300.000 F
Prothèses dentaires 80% 90% 100%
Kinésithérapie
Optique (adulte) (2ans) 80% 60.000 F 90% 100.000 F 100% 150.000 F
Optique (enfant) (2ans) 80% 60.000 F 90% 100.000 F 100% 150.000 F
Transport ambulancier 80% 20.000 F 90% 30.000 F 100% 40.000 F
Complément d'avis médical non garantit non garantit non garantit
Capital assistance funéraire 500.000 F 1.000.000 F 1.500.000 F
Plafond de dépenses annuelles par assuré 1.500.000 F 3.000.000 F 6.000.000 F
Plafond de dépenses annuelles par famille 2.500.000 F 5.000.000 F 10.000.000 F

Réseau de soins PREMIUM PREMIUM PREMIUM

Classification produit 80% 80% 100%

Délais de carence soins courants 3 mois 3 mois 3 mois

Délais de carence lunetterie 6 mois 6 mois 6 mois
Délais de carence soins dentaires 3 mois 3 mois 3 mois
Délais de carence prothèses 10 mois 10 mois 10 mois
Délais de carence maternité 10 mois 10 mois 10 mois
Délais de carence affections chroniques 12 mois 12 mois 12 mois

PRIMES TTC
PRIX PAR PERSONNE 102 197 240 084 391 850
PRIX PAR FAMILLE 330 307 717 562 1 406 105
PRIX PAR ENFANT SUPPLEMENTAIRE 44 280 44 280 44 280

Photo4:Presentation of the products of the company "B"

Source: The Student

c- Company C
Company C offers 2 products, each with a coverage rate of 80%. The guarantee ceilings per
family vary between 3,000,000 and 5,000,000 FCFA.

65
Compagnie C

Produit Option 1 Option 2

Garanties Taux Plafond/an Taux Plafond/an

Consultation Généraliste 80% 140.000 F 80% 180.000 F
Consultation Spécialiste 80% 140.000 F 80% 180.000 F
Pharmacie 80% 140.000 F 80% 180.000 F
Frais liés au VIH / SIDA
Analyses médicales 80% 140.000 F 80% 180.000 F
Imagerie médicale 80% 140.000 F 80% 180.000 F
Examens et Petits soins 80% 140.000 F 80% 180.000 F
Hospitalisation Médicale 80% 150.000 F / cas 80% 160.000 F / cas
Hospitalisation Chirurgicale 80% 300.000 F / cas 80% 350.000 F / cas
Chambre en Hospitalisation Forfait 20.000 F Forfait 25.000 F
Accouchement simple 80% 200.000 F 80% 200.000 F
Accouchement gémellaire 80% 200.000 F 80% 250.000 F
Accouchement par césarienne 80% 300.000 F 80% 350.000 F
Frais pré et post natal 80% Frais réels 80% Frais réels
Soins dentaires 80% 60.000 F 80% 80.000 F
Prothèses dentaires Forfait 50.000 F Forfait 80.000 F
Kinésithérapie non garantit non garantit
Optique (adulte) (2ans) 80% 60.000 F 80% 80.000 F
Optique (enfant) (2ans) 80% 60.000 F 80% 80.000 F
Transport ambulancier non garantit non garantit
Complément d'avis médical non garantit non garantit
Capital assistance funéraire 1.000.000 F 1.000.000 F
Plafond de dépenses annuelles par assuré 1.000.000 F 2.000.000 F
Plafond de dépenses annuelles par famille 3.000.000 F 5.000.000 F

Réseau de soins PREMIUM PREMIUM

Classification produit 80% 80%

Délais de carence soins courants 1 mois 1 mois

Délais de carence lunetterie 6 mois 6 mois
Délais de carence soins dentaires 1 mois 1 mois
Délais de carence prothèses 6 mois 6 mois
Délais de carence maternité 9 mois 9 mois
Délais de carence affections chroniques 12 mois 12 mois

PRIMES TTC
PRIX PAR PERSONNE 99 000 178 000
PRIX PAR FAMILLE 350 000 560 000
PRIX PAR ENFANT SUPPLEMENTAIRE 69 300 124 600

Photo5: Presentation of the products of the company "C"

d- Company D
Company D offers 3 products, two of which have a coverage rate of 80% and one with a rate
of 100%. The guarantee ceilings per family vary between 1,500,000 and 6,000,000 FCFA.

66
Compagnie D

Produit Option 1 Option 2 Option 3

Garanties Taux Plafond/an Taux Plafond/an Taux Plafond/an

Consultation Généraliste 80% 100.000 F 80% 200.000 F 100% Frais réels
Consultation Spécialiste 80% 100.000 F 80% 200.000 F 100% Frais réels
Pharmacie 80% 130.000 F 80% 260.000 F 100% Frais réels
Frais liés au VIH / SIDA
Analyses médicales 80% 120.000 F 80% 240.000 F 100% Frais réels
Imagerie médicale 80% 100.000 F 80% 200.000 F 100% Frais réels
Examens et Petits soins non garantit non garantit 100% Frais réels
Hospitalisation Médicale 80% 150.000 F / cas, 80% 300.000 F / cas, 100% Frais réels
Hospitalisation Chirurgicale 80% max 2 fois / an 80% max 2 fois / an 100% Frais réels
Chambre en Hospitalisation 80% 20.000 F 80% 20.000 F 100% 30.000 F
Accouchement simple 80% 150.000 F 80% 250.000 F 100% 300.000 F
Accouchement gémellaire 80% 200.000 F 80% 300.000 F 100% 350.000 F
Accouchement par césarienne 80% 300.000 F 80% 350.000 F 100% 400.000 F
Frais pré et post natal 80% 100.000 F 80% 200.000 F 100% 400.000 F
Soins dentaires 80% 80% 100%
80.000 F 160.000 F 250.000 F
Prothèses dentaires 80% 80% 100%
Kinésithérapie non garantit non garantit non garantit
Optique (adulte) (2ans) 80% 60.000 F 80% 60.000 F 100% 100.000 F
Optique (enfant) (2ans) 80% 60.000 F 80% 60.000 F 100% 100.000 F
Transport ambulancier 80% 20.000 F 80% 25.000 F 100% 30.000 F
Complément d'avis médical non garantit non garantit non garantit
Capital assistance funéraire non garantit non garantit non garantit
Plafond de dépenses annuelles par assuré 1.000.000 F 2.000.000 F 4.000.000 F
Plafond de dépenses annuelles par famille 1.500.000 F 3.000.000 F 6.000.000 F

Réseau de soins PREMIUM PREMIUM PREMIUM

Classification produit 80% 80% 100%

Délais de carence soins courants 2 mois 2 mois 2 mois

Délais de carence lunetterie 6 mois 6 mois 6 mois
Délais de carence soins dentaires 2 mois 2 mois 2 mois
Délais de carence prothèses 6 mois 6 mois 6 mois
Délais de carence maternité 9 mois 9 mois 9 mois
Délais de carence affections chroniques 12 mois 12 mois 12 mois

PRIMES TTC
PRIX PAR PERSONNE 113 040 221 040 346 710
PRIX PAR FAMILLE 339 840 675 025 1 052 034
PRIX PAR ENFANT SUPPLEMENTAIRE 53 041 53 041 53 041

Photo6: Presentation of the products of the company "D"

Source: The Student

e- Company E
Company E offers 2 products, one with an 80% coverage rate and the other with a 100%
coverage rate. The guarantee ceilings per individual vary between 5,000,000 and 10,000,000
FCFA.

67
Compagnie E

Produit 80% 100%

Garanties Taux Plafond/an Taux Plafond/an

Consultation Généraliste 80% Frais réels 100% Frais réels
Consultation Spécialiste 80% Frais réels 100% Frais réels
Pharmacie 80% Frais réels 100% Frais réels
Frais liés au VIH / SIDA
Analyses médicales 80% Frais réels 100% Frais réels
Imagerie médicale 80% Frais réels 100% Frais réels
Examens et Petits soins 80% Frais réels 100% Frais réels
Hospitalisation Médicale 80% Frais réels 100% Frais réels
Hospitalisation Chirurgicale 80% Frais réels 100% Frais réels
Chambre en Hospitalisation 80% 25.000 F 100% 40.000 F
Accouchement simple 80% 200.000 F 100% 400.000 F
Accouchement gémellaire 80% 300.000 F 100% 450.000 F
Accouchement par césarienne 80% 450.000 F 100% 500.000 F
Frais pré et post natal 80% Frais réels 100% Frais réels
Soins dentaires 80% 100%
200.000 F 200.000 F
Prothèses dentaires 80% 100%
Kinésithérapie 80% 100.000 F 100% 100.000 F
Optique (adulte) (2ans) 80% 100.000 F 100% 150.000 F
Optique (enfant) (2ans) 80% 70.000 F 100% 100.000 F
Transport ambulancier 80% 20.000 F 100% 30.000 F
Complément d'avis médical non garantit non garantit
Capital assistance funéraire non garantit non garantit
Plafond de dépenses annuelles par assuré 5.000.000 F 10.000.000 F
Plafond de dépenses annuelles par famille

Réseau de soins STANDARD STANDARD

Classification produit 80% 100%

Délais de carence soins courants

Délais de carence lunetterie
Délais de carence soins dentaires
Délais de carence prothèses
Délais de carence maternité
Délais de carence affections chroniques

PRIMES TTC
PRIX PAR PERSONNE 434 647 604 185
PRIX PAR FAMILLE 1 066 235 1 769 859
PRIX PAR ENFANT SUPPLEMENTAIRE

Photo7: Presentation of the products of the company "E"

Source: The Student

f- Company F
Company F offers 3 products, each with a coverage rate of 80%, 90% and 100%. The guarantee
ceilings per family vary between 15,000,000 and 20,000,000 FCFA.

68
Compagnie F

Produit 80% 90% 100%

Garanties Taux Plafond/an Taux Plafond/an Taux Plafond/an

Consultation Généraliste 80% Frais réels 90% Frais réels 100% Frais réels
Consultation Spécialiste 80% Frais réels 90% Frais réels 100% Frais réels
Pharmacie 80% Frais réels 90% Frais réels 100% Frais réels
Frais liés au VIH / SIDA 80% 350.000 F 90% 400.000 F 100% 500.000 F
Analyses médicales 80% Frais réels 90% Frais réels 100% Frais réels
Imagerie médicale 80% Frais réels 90% Frais réels 100% Frais réels
Examens et Petits soins 80% Frais réels 90% Frais réels 100% Frais réels
Hospitalisation Médicale 80% Frais réels 90% Frais réels 100% Frais réels
Hospitalisation Chirurgicale 80% Frais réels 90% Frais réels 100% Frais réels
Chambre en Hospitalisation 80% 35.000 F 90% 40.000 F 100% 45.000 F
Accouchement simple 80% 300.000 F 90% 350.000 F 100% 400.000 F
Accouchement gémellaire 80% 400.000 F 90% 450.000 F 100% 500.000 F
Accouchement par césarienne 80% 500.000 F 90% 600.000 F 100% 700.000 F
Frais pré et post natal 80% Frais réels 90% Frais réels 100% Frais réels
Soins dentaires 80% 90% 100%
200.000 F 250.000 F 300.000 F
Prothèses dentaires 80% 90% 100%
Kinésithérapie 80% 150.000 F 90% 150.000 F 100% 200.000 F
Optique (adulte) (2ans) 80% 150.000 F 90% 180.000 F 100% 200.000 F
Optique (enfant) (2ans) 80% 100.000 F 90% 110.000 F 100% 125.000 F
Transport ambulancier 80% 50.000 F 90% 75.000 F 100% 100.000 F
Complément d'avis médical 80% Frais réels 90% Frais réels 100% Frais réels
Capital assistance funéraire non garantit non garantit non garantit
Plafond de dépenses annuelles par assuré 7.500.000 F 8.000.000 F 10.000.000 F
Plafond de dépenses annuelles par famille 15.000.000 F 16.000.000 F 20.000.000 F

Réseau de soins STANDARD STANDARD STANDARD

Classification produit 80% 90% 100%

Délais de carence soins courants

Délais de carence lunetterie
Délais de carence soins dentaires
Délais de carence prothèses
Délais de carence maternité
Délais de carence affections chroniques

PRIMES TTC
PRIX PAR PERSONNE 391 200 457 200 536 400
PRIX PAR FAMILLE
PRIX PAR ENFANT SUPPLEMENTAIRE

Photo8: Presentation of the products of the company "F"

Source: The Student

g- Company G
Company G offers 4 products, each with a coverage rate of 70%, 80%, 90% and 100%. The
guarantee ceilings per family vary between 15,000,000 and 30,000,000 FCFA.

69
Compagnie G

Produit 70% 80% 90% 100%

Garanties Taux Plafond/an Taux Plafond/an Taux Plafond/an Taux Plafond/an

Consultation Généraliste 70% Frais réels 80% Frais réels 90% Frais réels 100% Frais réels
Consultation Spécialiste 70% Frais réels 80% Frais réels 90% Frais réels 100% Frais réels
Pharmacie 70% Frais réels 80% Frais réels 90% Frais réels 100% Frais réels
Frais liés au VIH / SIDA non garantit non garantit non garantit non garantit
Analyses médicales 70% Frais réels 80% Frais réels 90% Frais réels 100% Frais réels
Imagerie médicale 70% Frais réels 80% Frais réels 90% Frais réels 100% Frais réels
Examens et Petits soins 70% Frais réels 80% Frais réels 90% Frais réels 100% Frais réels
Hospitalisation Médicale 70% Frais réels 80% Frais réels 90% Frais réels 100% Frais réels
Hospitalisation Chirurgicale 70% Frais réels 80% Frais réels 90% Frais réels 100% Frais réels
Chambre en Hospitalisation 70% 20.000 F 80% 30.000 F 90% 40.000 F 100% 40.000 F
Accouchement simple 70% 200.000 F 80% 250.000 F 90% 400.000 F 100% 400.000 F
Accouchement gémellaire 70% 250.000 F 80% 300.000 F 90% 450.000 F 100% 450.000 F
Accouchement par césarienne 70% 400.000 F 80% 450.000 F 90% 650.000 F 100% 650.000 F
Frais pré et post natal 70% Frais réels 80% Frais réels 90% Frais réels 100% Frais réels
Soins dentaires 70% 80.000 F 80% 120.000 F 90% 200.000 F 100% 200.000 F
Prothèses dentaires 70% 80.000 F 80% 120.000 F 90% 200.000 F 100% 200.000 F
Kinésithérapie 70% Frais réels 80% Frais réels 90% Frais réels 100% Frais réels
Optique (adulte) (2ans) 70% 60.000 F 80% 80.000 F 90% 100.000 F 100% 100.000 F
Optique (enfant) (2ans) 70% 40.000 F 80% 50.000 F 90% 60.000 F 100% 60.000 F
Transport ambulancier 70% 20.000 F 80% 30.000 F 90% 40.000 F 100% 40.000 F
Complément d'avis médical non garantit non garantit non garantit non garantit
Capital assistance funéraire non garantit non garantit non garantit non garantit
Plafond de dépenses annuelles par assuré 7.500.000 F 10.000.000 F 15.000.000 F 15.000.000 F
Plafond de dépenses annuelles par famille 15.000.000 F 20.000.000 F 30.000.000 F 30.000.000 F

Réseau de soins STANDARD STANDARD STANDARD STANDARD

Classification produit 70% 80% 90% 100%

Délais de carence soins courants

Délais de carence lunetterie
Délais de carence soins dentaires
Délais de carence prothèses
Délais de carence maternité
Délais de carence affections chroniques

PRIMES TTC
PRIX PAR PERSONNE 276 420 385 641 462 769 555 323
PRIX PAR FAMILLE
PRIX PAR ENFANT SUPPLEMENTAIRE

Photo9: Presentation of the products of the company "G"

Source: The Student

5- Claims rates
The loss ratios that we used were calculated from historical claims data in the health sector in
the CIMA zone.

a- Description of the data used

The history of claims expenses on the Health branch of a health manager in the CIMA zone is
first broken down by individuals treated in total over the 2020 financial year.
The following variables are associated with each individual: The age of the individual, the total
amount of care per medical procedure, the total amount of care reimbursed per medical
procedure and the total amount of care not reimbursed per medical procedure . We were
specifically interested in the expenses reimbursed according to age and grouping of acts.
Finally, we completed our variables by calculating the percentage of expenses reimbursed for
70
a category of medical acts by calculating the ratio of the expenses reimbursed for a category
and the total amount of expenses reimbursed.

b- Curve of claims rates by family of medical procedures

After grouping the medical acts by headings, we obtain a total of 10 headings. The expense
rates reimbursed by Age are represented graphically on a curve.
Specialized Acts
Specialized acts represent on average 1.16% of total expenses reimbursed. There is a slight
increase in the rates until the age of 79 before experiencing a decline.

Figure1: Graphical representation of the claims expense ratios of specialized procedures

according to the age of the beneficiaries
Source: The Student

Analyses
The analyzes represent on average 5.85% of the total expenses reimbursed. There is a slight
increase in the rates until the age of 78 before experiencing a decline.

71
Figure2:Graphical representation of the claims cost rates of analyzes according to the age of
the beneficiaries
Source: The Student

Dental Care
Dental care represents on average 1.20% of total reimbursed expenses. Rates are stable until
the age of 65 before experiencing a decline.

Figure3: Graphic representation of dental care claims rates according to the age of the
beneficiaries
Source: The Student

72
Medical Fees
Medical fees represent on average 15.57% of total reimbursed costs. There is a slight increase
in the rates until the age of 79 before experiencing a decline.

Figure4: Graphical representation of the claims costs of medical consultations according to

the age of the beneficiaries
Source: The Student
Hospitalization
Hospitalization care represents the largest share of reimbursed expenses. The average rate is
around 60% until the age of 77% before experiencing a gradual and considerable increase.

Figure5:Graphic representation of the hospitalization claims rates according to the age of the
beneficiaries
Source: The Student

73
Maternity
Maternity represents on average 5.08% of total reimbursed expenses. There is a slight drop in
rates from the age of 47 and then a drastic drop in the rate from the age of 55.

Figure6:Graphical representation of claims rates for maternity care according to the age of
the beneficiaries
Source: The Student

Pharmacy
Pharmacies represent less than 1% of total reimbursed expenses. We observe a stability around
0.38% until the age of 83 before experiencing a decline.

Figure7: Graphic representation of pharmacy claims rates according to the age of the
beneficiaries
Source: The Student
74
Radiology
Radiology care represents on average 11.07% of total reimbursed expenses. There is a slight
increase in the rates until the age of 79 before experiencing a decline.

Figure8: Graphic representation of radiology claims rates according to the age of the
beneficiaries
Source: The Student

Costly long-term treatments

These treatments represent less than 1% of the total reimbursed costs. There is a slight increase
in the rates until the age of 79 before experiencing a decline.

Figure9: Graphical representation of the loss ratios of expensive treatments according to the
age of the beneficiaries
Source: The Student

75
Various
Miscellaneous care represents less than 1% of reimbursed costs. They hover around 0.16%
until the age of 85.

Figure10: Graphical representation of miscellaneous care claim rates according to the age of
the beneficiaries
Source: The Student

Breakdown of expenses reimbursed by item

The graph below shows us that the majority of care is due to hospitalizations.

Figure11: Graphical breakdown of reimbursed claims expense rates by item

Source: The Student
76
 6- Mortality tables
In the CIMA zone, the mortality tables used are the CIMA H and CIMA F tables.
The table we used in our model is the CIMA F table because it is the one required for any
product whose risk is survival or longevity.
The table below therefore presents the CIMA F table with a sample of 1,000,000 people at the
starting age x=0. This distribution extends to age 106. From x= 106, we consider that the
population is reduced to 0. That is, the probability of survival at age 106 is equal to 0. The
variables which appear there are: Age, Lx (the number of individuals alive at an age x), qx (the
death rate at age x), px (the survival rate at l age x) and dx (the number of deaths at age x).

Table 7: CIMA F mortality table

Lx qx (CIMA px (CIMA dx (CIMA
Age
(CIMA F) F) F) F)
0 1,000,000 0.2849% 99.7151% 2,849
1 997 151 0.0387% 99.9613% 386
2 996 766 0.0296% 99.9704% 295
3 996 470 0.0252% 99.9748% 252
4 996 219 0.0216% 99.9784% 215
5 996 004 0.0197% 99.9803% 196
6 995 808 0.0177% 99.9823% 177
7 995 631 0.0167% 99.9833% 167
8 995 465 0.0167% 99.9833% 167
9 995 298 0.0157% 99.9843% 156
10 995 142 0.0167% 99.9833% 167
11 994 975 0.0167% 99.9833% 167
12 994 809 0.0197% 99.9803% 196
13 994 613 0.0235% 99.9765% 233
14 994 380 0.0288% 99.9712% 286
Source: CIMA

Paragraph 2: Determination of the Net Premium of health coverage for retirees of Mutual X
Before moving on to modeling, we must use the health products collected on the market in
order to determine the adequate insurance premium that will allow the viability of our
product from a technical point of view.

1- Benefits table and Basic premium

Thanks to the loss rates per act and the rules of proportionality, we can determine the basic
health premium for this following guarantee table:

77
 Table 8: Table of benefits for the health product for retirees
Acts Benefits Option Ceiling/Year

General consultation General consultation (telemedicine) 80% According to approved tariffs

Specialist consultation Specialized consultation (telemedicine) 80% According to approved tariffs

Pharmacy Real costs 80% Real costs

Minor examinations and care Minor examinations and care 80% Real costs

Medical and surgical hospitalization with

Hospitalization 80% Real costs
hospitalization room 30,000 CFA/day

ENT Conditions & Surgery 80% Real costs

Speech therapy Speech therapy Excluded except accident

Dental care Real costs

Dental care and prostheses 80%
Dental imaging 250,000 CFA

Kinesitherapy and functional

Kinesitherapy and functional physiotherapy 80% 6,000/session
physiotherapy

Treatment and tests (ophthalmology) Real costs

Surgery (ophthalmology) Real costs
Excluded, except corrective lenses
Ophthalmology and optics 80%
Optical lenses capped at 100,000 every 2
years/insured
Lens processing Excluded
50,000 CFA in direct reimbursement
Ambulance Ambulance 80%
/ event
Annual ceiling per family/year 10,000,000
Network of Providers Enhanced Network

78
Source: The Student
We agreed to use the products of companies A, E, F and G because they best met the guarantees
that mutual X has drawn up in this table of guarantees. The pure premiums obtained from each
comparison made will be added and divided by their number, which gives us the following
equality:
6789: 6<7: (=) 0 6789: 6<7: (>) 0 6789: 6<7: (?) 0 6789: 6<7: (@)
Pure Premium (Leadway)= A

Thus, we obtain the following pure premiums for each company:

a- Base bonus obtained from company E

The difference between benefits is obtained by taking the difference between the benefit value
of Leadway and that of company E. As an example, we have Dentures which have a benefit
value of 200,000 for company E and a value of 100,000 for Leadway. The guarantee difference
(D) is: D = (100,000 – 200,000) /200,000 = -0.5 or -50%
The proportion of difference for each procedure is the product of the Proportion of the family
of procedures concerned by the difference in cover. This gives us for the previous case:
P = -50% * 1.10% = -0.55%
The premium is determined by calculating the product of the sum of the proportions of
difference per act with the original insurance premium. That is, P(E) = -6.99% * 392,262 =
364,850 CFA.
So the pure premium (E) = 364,850 CFA.
Option 80%

Actes par famille Proportion E Leadway Différence entre les garanties Proportion de difference pour cet acte
PHARMACIE 30,38% 0% 0,00%
HONORAIRES MEDICAUX 18,82% 0% 0,00%
HOSPITALISATION MEDICALE 12,62% 0% 0,00%
LABORATOIRE 9,79% 0% 0,00%
OPTIQUE 5,68% 0% 0,00%
RADIOLOGIE 3,96% 0% 0,00%
ACCOUCHEMENT 4,86% 450 000 - -100% -4,86%
HOSPITALISATION CHIRURGICALE 4,46% 0% 0,00%
SOINS DENTAIRES 1,76% 0% 0,00%
EXPLORATIONS FONCTIONNELLES 1,74% 0% 0,00%
MATERNITE 1,62% 1 000 000 - -100% -1,62%
AUXILIAIRES MEDICAUX 1,60% 0% 0,00%
PROTHESES DENTAIRES 1,10% 200 000 100 000 -50% -0,55%
MISE EN OBSERVATION EN ETABLISSEMENT 0,28% 0% 0,00%
NEONATALOGIE (COUVEUSE) 0,14% 1 000 000 - -100% -0,14%
Autre prothèses 0,75% 0% 0,00%
ACTES SPECIALISES 0,17% 0% 0,00%
SOINS INTENSIFS 0,16% 0% 0,00%
Ambulance 0,12% 20 000 50 000 150% 0,18%
Total 100% -200% -6,99%

Prime pure 392 262 364 850

Photo10: Pricing by comparative analysis between the guarantees of the company "E" and
Leadway
Source: The Student

79
 b- Base bonus obtained from Company A
The pure premium (A) = 284,963 CFA.
Option 80%

Actes par famille Proportion A Leadway Différence entre les garanties Proportion de difference pour cet acte
PHARMACIE 30,38% 0% 0,0%
HONORAIRES MEDICAUX 18,82% 0% 0,0%
HOSPITALISATION MEDICALE 12,62% 35 000 25 000 -29% -3,6%
LABORATOIRE 9,79% 0% 0,0%
OPTIQUE 5,68% 0% 0,0%
RADIOLOGIE 3,96% 0% 0,0%
ACCOUCHEMENT 4,86% 450 000 - -100% -4,9%
HOSPITALISATION CHIRURGICALE 4,46% 0% 0,0%
SOINS DENTAIRES 1,76% 260 000 200 000 -23% -0,4%
EXPLORATIONS FONCTIONNELLES 1,74% 0% 0,0%
MATERNITE 1,62% 1 000 000 - -100% -1,6%
AUXILIAIRES MEDICAUX 1,60% 0% 0,0%
PROTHESES DENTAIRES 1,10% 260 000 100 000 -62% -0,7%
MISE EN OBSERVATION EN ETABLISSEMENT 0,28% 0% 0,0%
NEONATALOGIE (COUVEUSE) 0,14% 1 000 000 - -100% -0,1%
Autre prothèses 0,75% 0% 0,0%
ACTES SPECIALISES 0,17% 0% 0,0%
SOINS INTENSIFS 0,16% 0% 0,0%
Ambulance 0,12% 30 000 50 000 67% 0,1%
Total 100% -347% -11%

Prime pure 321 000 284 963

Photo11: Pricing by comparative analysis between the guarantees of company "A" and
Leadway
Source: The Student

c- Base bonus obtained from Company F

The pure premium (F) = 341,649 CFA.
Option 80%

Actes par famille Proportion F Leadway Différence entre les garanties Proportion de difference pour cet acte
PHARMACIE 30,38% 0% 0,0%
HONORAIRES MEDICAUX 18,82% 0% 0,0%
HOSPITALISATION MEDICALE 12,62% 35 000 25 000 -29% -3,6%
LABORATOIRE 9,79% 0% 0,0%
OPTIQUE 5,68% 150 000 100 000 -33% -1,9%
RADIOLOGIE 3,96% 0% 0,0%
ACCOUCHEMENT 4,86% 500 000 - -100% -4,9%
HOSPITALISATION CHIRURGICALE 4,46% 0% 0,0%
SOINS DENTAIRES 1,76% 0% 0,0%
EXPLORATIONS FONCTIONNELLES 1,74% 0% 0,0%
MATERNITE 1,62% 1 000 000 - -100% -1,6%
AUXILIAIRES MEDICAUX 1,60% 0% 0,0%
PROTHESES DENTAIRES 1,10% 200 000 100 000 -50% -0,5%
MISE EN OBSERVATION EN ETABLISSEMENT 0,28% 0% 0,0%
NEONATALOGIE (COUVEUSE) 0,14% 1 000 000 - -100% -0,1%
Autre prothèses 0,75% 0% 0,0%
ACTES SPECIALISES 0,17% 0% 0,0%
SOINS INTENSIFS 0,16% 0% 0,0%
Ambulance 0,12% 0% 0,0%
Total 100% -412% -13%

Prime pure 391 200 341 649

Photo12: Pricing by comparative analysis between the guarantees of the company "F" and
Leadway
Source: The Student

d- Base bonus obtained from Company G

The pure premium (G) = 357,076 CFA.

80
Option 80%

Actes par famille Proportion G Leadway Différence entre les garanties Proportion de difference pour cet acte
PHARMACIE 30,38% 0% 0,0%
HONORAIRES MEDICAUX 18,82% 0% 0,0%
HOSPITALISATION MEDICALE 12,62% 30 000 25 000 -17% -2,1%
LABORATOIRE 9,79% 0% 0,0%
OPTIQUE 5,68% 80 000 100 000 25% 1,4%
RADIOLOGIE 3,96% 0% 0,0%
ACCOUCHEMENT 4,86% 450 000 - -100% -4,9%
HOSPITALISATION CHIRURGICALE 4,46% 0% 0,0%
SOINS DENTAIRES 1,76% 0% 0,0%
EXPLORATIONS FONCTIONNELLES 1,74% 0% 0,0%
MATERNITE 1,62% 1 000 000 - -100% -1,6%
AUXILIAIRES MEDICAUX 1,60% 0% 0,0%
PROTHESES DENTAIRES 1,10% 120 000 100 000 -17% -0,2%
MISE EN OBSERVATION EN ETABLISSEMENT 0,28% 0% 0,0%
NEONATALOGIE (COUVEUSE) 0,14% 1 000 000 - -100% -0,1%
Autre prothèses 0,75% 0% 0,0%
ACTES SPECIALISES 0,17% 0% 0,0%
SOINS INTENSIFS 0,16% 0% 0,0%
Ambulance 0,12% 30 000 50 000 67% 0,1%
Total 100% -242% -7%

Prime pure 385 641 357 076

Photo13: Pricing by comparative analysis between the guarantees of the company "G" and
Leadway
Source: The Student

BCA DE5 0 FDA GCB 0 BA* CAG 0 BEH 5HC

The Pure Leadway premium = A
= 337,134 CFA.

2- Application of claims rates per medical procedure and determination of

the Net Annual Premium
We have constructed a table of claims based on the size of our population and the analysis of
claims costs according to medical procedures.
The average age of the population subjected to our study is 45 years. The determined pure
premium is then increased by the loss rates according to the medical procedures at the age of
60 and 65. In other words, the rate of increase for each medical procedure at age 60 tA(60) =
and the rate of increase for each medical procedure at age 65 tA(65) = . This implies that each
individual will have the same risk profile at retirement age according to the basic category. We
will then draw up the table of additional premium rates applicable to the pure
IJ"JK'LMK MK'J,éK (OPM C5) IJ"JK'LMK MK'J,éK (OPM CE)
premium:IJ"JK'LMK MK'J,éK (OPM ,QRM") J"JK'LMK MK'J,éK (OPM ,QRM")

81
Table 9: Rate of increase in claims by medical procedures

MEDICAL ACTS DEPARTURE AT 60 LEAVING AT 65

PHARMACY 100.00% 100.00%
CONSULTATION 110.13% 113.50%
MEDICAL HOSPITALIZATION 105.68% 107.58%
LABORATORY 109.73% 112.97%
OPTICAL 100.00% 100.00%
RADIOLOGY 118.92% 125.22%
CHILDBIRTH X X
SURGICAL HOSPITALIZATION 105.68% 107.58%
DENTAL CARE 100.00% 100.00%
FUNCTIONAL EXPLORATIONS 100.00% 100.00%
MATERNITY X X
MEDICAL AUXILIARIES 100.00% 100.00%
DENTAL PROSTHESIS 100.00% 100.00%
OBSERVATION IN INSTITUTION 100.00% 100.00%
NEONATALOGY (INCUBATOR) X X
OTHER PROSTHESES 100.00% 100.00%
SPECIALIZED ACTS 109.49% 112.66%
INTENSIVE CARE 100.00% 100.00%
AMBULANCE 100.00% 100.00%
Source: The Student
Each additional premium on a medical act is applied to the pure premium proportion of this
medical act in question:

Table 10: Application of the growth rates to the pure premium

Breakdown of the pure premium by medical
procedure Rate 60 Rate 65
Pure Premium Pharmacy 102,421 102,421
Pure Premium Consultations 69,876 72,014
Pure Premium Medical Hospitalizations 44,963 45,771
Prime Pure Laboratory 36,217 37,286
Pure Premium Optics 19,149 19,149
Pure Premium Radiology 15,876 16,718
Pure Premium Specialized Acts 628 646
Pure Premium Surgical Hospitalization 15,890 16,176
Pure Premium Dental 9,642 9,642
Pure Premium Adjusted 352,624 357,785
Source: The Student

82
 a- Inflation rate assumption
The period of validity of the health cover runs from the date of retirement of each individual.
Therefore, it is necessary to consider the inflation factor of the values of the guarantees until
their effective dates.
We are therefore going to apply an arbitrary rate of 3.00% for the level of annual inflation of
the Pure Health Premium.

b- Net Annual Premium

The Net Annual Premium is the pure Premium increased by the rates of increase by medical
procedures of the retirement age and of inflation relating to age x. The new pure premium is
obtained by taking the sum of the pure premiums distributed by medical acts adjusted by the
rate of increase. Thus, we obtain the following relationship:
Net Annual Premium = Pure Adjusted Premium (Age 60 or 65) * age inflation rate x
Table11: Determination of the Net Premium
Employee's Years before Annual Health
ID Category Date of birth Position Eligible
age retirement Premium
E1 C 10/19/64 ACTIVE 58 2 FALSE Excluded

E2 A 10/14/78 ACTIVE 44 21 TRUE CFA 665,585

E3 A 03/07/74 ACTIVE 48 17 TRUE CFA 591,364

E4 A 05/31/80 ACTIVE 42 23 TRUE CFA 706,119

E5 C 01/05/80 ACTIVE 42 18 TRUE CFA 600,318

E6 A 1976 ACTIVE 46 19 TRUE CFA 627,378

E7 A 1976 ACTIVE 46 19 TRUE CFA 627,378

E8 A 12/09/67 ACTIVE 55 10 TRUE CFA 480,833

E9 B 1976 ACTIVE 46 14 TRUE CFA 533,375

E10 A 12/12/77 ACTIVE 45 20 TRUE CFA 646,199

E11 A 6/26/66 ACTIVE 56 9 TRUE CFA 466,828

E12 A 08/07/57 ACTIVE 65 0 FALSE Excluded

E13 A 12/04/88 ACTIVE 34 31 TRUE CFA 894,490

E14 A 12/13/77 ACTIVE 45 20 TRUE CFA 646,199

E15 B 10/08/83 ACTIVE 39 21 TRUE CFA 655,984

E16 A 03/17/73 ACTIVE 49 16 TRUE CFA 574,139

E17 C 10/02/84 ACTIVE 38 22 TRUE CFA 675,664

E18 B 11/12/89 ACTIVE 33 27 TRUE CFA 783,279

E19 B 06/13/78 ACTIVE 44 16 TRUE CFA 565,858

E20 B 04/25/83 ACTIVE 39 21 TRUE CFA 655,984

83
Source: The Student
Paragraph 3: Determination of Present Values of benefits and contributions per individual
The present value of the benefits consists in calculating the future value of the commitments
of the insured and discounting them until the retirement date of each individual.
Clearly, this amounts to calculating the present value of the annual health premiums that the
mutual will have to pay at the beginning of each period if and only if the main insured is still
alive. We will therefore speak of Likely Present Value (LPV), which is the product of the
present value of the commitment to pay health premiums each year by the probability of
achieving this commitment.
1- Present Values
Two discount factors a60 et a65 are defined for the retirement dates according to the predefined
categories.
*
We have: ax = (1 + ∑*5E4& "
")* 𝑣 ) * tPx (with v =*0J , i being the arbitrary investment interest rate

*
equal to 3.00% and tPx the probability of an individual of age x surviving t years).∑*5E4& "
")* 𝑣 *0J

Thus, we have:
a60 = (1 + ∑AE " A5 "
")* 𝑣 ) * 45P60 et a65 = (1 + ∑")* 𝑣 ) * 40P65

Which implies that a60 = 12,72 et a65 = 11,82.

The present value (PV) of the benefits therefore gives us the following table:

84
 Table12: Determination of the Present Value of the total contributions
Last name Years Annual
Date of Employee's Present Value
and first Category Position before Eligible Health
birth age of Benefits
names retirement Premium
E1 C 10/19/64 ACTIVE 58 2 FALSE Excluded Excluded
E2 A 10/14/78 ACTIVE 44 21 TRUE CFA 665,585 CFA 8,469,262
E3 A 03/07/74 ACTIVE 48 17 TRUE CFA 591,364 CFA 6,987,558
E4 A 05/31/80 ACTIVE 42 23 TRUE CFA 706,119 CFA 8,343,510
E5 C 01/05/80 ACTIVE 42 18 TRUE CFA 600,318 CFA 7,093,368
E6 A 1976 ACTIVE 46 19 TRUE CFA 627,378 CFA 7,983,091
E7 A 1976 ACTIVE 46 19 TRUE CFA 627,378 CFA 7,413,100
E8 A 12/09/67 ACTIVE 55 10 TRUE CFA 480,833 CFA 5,681,524
E9 B 1976 ACTIVE 46 14 TRUE CFA 533,375 CFA 6,302,366
E10 A 12/12/77 ACTIVE 45 20 TRUE CFA 646,199 CFA 8,222,584
E11 A 6/26/66 ACTIVE 56 9 TRUE CFA 466,828 CFA 5,516,043
E12 A 08/07/57 ACTIVE 65 0 FALSE Excluded Excluded
A CFA
E13 12/04/88 ACTIVE 34 31 TRUE CFA 894,490
10,569,308
E14 A 12/13/77 ACTIVE 45 20 TRUE CFA 646,199 CFA 7,635,493
E15 B 10/08/83 ACTIVE 39 21 TRUE CFA 655,984 CFA 7,751,115
E16 A 03/17/73 ACTIVE 49 16 TRUE CFA 574,139 CFA 7,305,660
E17 C 10/02/84 ACTIVE 38 22 TRUE CFA 675,664 CFA 7,983,648
E18 B 11/12/89 ACTIVE 33 27 TRUE CFA 783,279 CFA 9,966,869
E19 B 06/13/78 ACTIVE 44 16 TRUE CFA 565,858 CFA 7,200,278
E20 B 04/25/83 ACTIVE 39 21 TRUE CFA 655,984 CFA 8,347,096
Source: The Student

2- Contributions
To calculate the value of the contributions per individual, we apply the principle of equality of
the VAP of the insured and the insurer. For our case, it is a question of writing the equality of
the commitments of the employee and those of the insurer who will pay annual health
premiums from the date of retirement of each individual. To do this, we assume that individuals
contribute until the date of retirement.
Note: C, the quarterly contribution of an employee; i(4) the equivalent quarterly interest rate;
8(A)
d = ; r is the number of years remaining before an individual retires.8(A)0*

We therefore have: VAP (Employee) = VAP (Insurer)

%∗'
S*0J(A)T 4*
óC * = PV U
VW∗U
óC= %∗'
S*0J(A)T 4*

85
 The numerical application of this equality gives us the following table:

Table13:Determination of periodic contributions

Last Number of
Annual Present
name Date of Employee's years Quarterly
Category Position Eligible Health Value of
and first birth age before dues
Premium Benefits
names retirement
E1 C 10/19/64 ACTIVE 58 2 FALSE Excluded Excluded Excluded
CFA CFA CFA
E2 A 10/14/78 ACTIVE 44 21 TRUE
665,585 8,469,262 72,481
A CFA CFA CFA
E3 03/07/74 ACTIVE 48 17 TRUE
591,364 6,987,558 78,802
A CFA CFA CFA
E4 05/31/80 ACTIVE 42 23 TRUE
706,119 8,343,510 63,095
CFA CFA CFA
E5 C 01/05/80 ACTIVE 42 18 TRUE
600,318 7,093,368 74,348
A CFA CFA CFA
E6 1976 ACTIVE 46 19 TRUE
627,378 7,983,091 78,002
A CFA CFA CFA
E7 1976 ACTIVE 46 19 TRUE
627,378 7,413,100 72,433
A CFA CFA CFA
E8 12/09/67 ACTIVE 55 10 TRUE
480,833 5,681,524 121,628
CFA CFA CFA
E9 B 1976 ACTIVE 46 14 TRUE
533,375 6,302,366 90,523
A CFA CFA CFA
E10 12/12/77 ACTIVE 45 20 TRUE
646,199 8,222,584 75,099
A CFA CFA CFA
E11 6/26/66 ACTIVE 56 9 TRUE
466,828 5,516,043 133,252
A
E12 08/07/57 ACTIVE 65 0 FALSE Excluded Excluded Excluded
A CFA CFA CFA
E13 12/04/88 ACTIVE 34 31 TRUE
894,490 10,569,308 51,875
A CFA CFA CFA
E14 12/13/77 ACTIVE 45 20 TRUE
646,199 7,635,493 69,737
CFA CFA CFA
E15 B 10/08/83 ACTIVE 39 21 TRUE
655,984 7,751,115 66,335
CFA CFA CFA
E16 A 03/17/73 ACTIVE 49 16 TRUE
574,139 7,305,660 88,948
CFA CFA CFA
E17 C 10/02/84 ACTIVE 38 22 TRUE
675,664 7,983,648 64,162
CFA CFA CFA
E18 B 11/12/89 ACTIVE 33 27 TRUE
783,279 9,966,869 60,085
CFA CFA CFA
E19 B 06/13/78 ACTIVE 44 16 TRUE
565,858 7,200,278 87,665
CFA CFA CFA
E20 B 04/25/83 ACTIVE 39 21 TRUE
655,984 8,347,096 71,435
Source: The Student

86
Section 2: Presentation of the results
This section aims to better interpret the results obtained from our pricing model applied to the
population of health insurance X.

Paragraph 1: Summary of benefits and contributions on the whole portfolio

This table below summarizes the number of employees by age bracket, the total estimated
quarterly contributions by bracket and the total value of benefits by bracket. For example, the
224 people between 3 and 5 years old are supposed to contribute an average of 66 million CFA
each quarter until retirement, all other things being equal.
We can also see that more than half of the members of mutual X have 16 years or more of
contributions before their retirement. It is therefore important for the mutual to have a
management policy for its savings fund which will be used to fund the health coverage of
retirees.

Table14: Summary of contributions by age group

Years before Number of Total estimated contributions by Total Value of Benefits by
retirement employees Quarter and by Age Group Age Group
< 3 years or
321 Excluded Excluded
Inactive
3-5 years 224 CFA 66,397,725 CFA 1,109,568,078
6-10 years 563 CFA 87,991,301 CFA 3,140,265,714
11-15 years 1115 CFA 103,954,950 CFA 7,241,322,697
16 years and over 2950 CFA 202,998,608 CFA 24,859,341,166
Total eligible 4852 CFA 461,342,584 CFA 36,350,497,655
Source: The Student

Paragraph 2: Methods of financing the savings fund

We have proposed 3 forms of financing for this savings fund, which are “the individual
financing formula”, “the corporate financing formula” and “the categorical financing formula”.

1- Individually funded formula

This is the simplest and most obvious formula. Each employee contributes to build up the
amount that will be needed to cover their retirement years. This option presents little solvency
risk for the savings fund. In addition, most of the population studied has more than ten (10)
years of contributions. However, contribution levels turn out to be very high for individuals

87
who are already approaching retirement. It will be difficult for them to be able to build up such
sums in such a short time.

2- Corporate financing formula

This formula consists of the employer defining its own financing strategy. The mutual would
define fixed amounts for employees to contribute until their retirement. That said, the mutual
is free to define an investment policy in order to compensate for the difference in contributions.
On the other hand, this formula presents great risks because the return on these investments is
not 100% guaranteed.

3- Block-funded formula
The principle of this financing method is the pooling of contributions by category of
employees. Clearly, it is a question of summing up all the quarterly contributions for employees
in the same category and determining an average quarterly contribution. This option represents
little solvency risk and considerably reduces the amounts of contributions for individuals as
the retirement date approaches. However, it modifies the actual commitments of the
policyholders, which could be interpreted as a lack of equity within the portfolio, although true
that it would also show a form of solidarity between the members of the mutual.

88
 CONCLUSION
At the end of this study on the design of a complementary health product for retirees in the
form of deferred financing, we note that the need to offer health coverage for the age group of
retirees does indeed exist.

The goal of our work is to design a formula of health coverage that can meet the needs of a
retirement plan even after having exceeded the age of being active.

In order to carry out this task, we first proceeded to the analysis of health coverage in Côte
d'Ivoire. We then defined the pricing of an innovative health insurance product. To achieve
this, we had to do a comparative study of existing health products on the Ivorian market. Next,
we determined an average annual premium for our retiree health coverage. Finally, using the
Excel spreadsheet, we modeled the commitments of the insured and the insurer in order to
obtain the premiums.

The analysis of the results allowed us to confirm the hypotheses put forward. Market products
do not take retirees into account. Also, the latter could not be able to afford health coverage on
a continuous basis after their retirement due to the high cost of health care which is only
changing day by day. We took the liberty of collecting existing products from the market in
order to design health coverage adapted to our target population. This determined coverage
served as a basis for us to then define a contribution plan for each individual in the pension
plan made available to us for this study.

In view of the results obtained, it would be wise for Leadway Vie to seize this opportunity with
a view to establishing a more imposing position on the Ivorian market of insurance companies.
This product represents an innovation that could allow Leadway to attract a large number of
people who will come with the aim of guaranteeing a retirement life guaranteed for life.

89
 BIBLIOGRAPHY
Works :
- CIMA (2018), Code des Assurances Édition 2019, 608 pages ;
- BAKAYOKO Saliou (2007), Fonctionnement technique et actuariel de
l’assurance vie & capitalisation, 117 pages ;
- BANQUE MONDIALE (2006), L’Assurance maladie en Afrique francophone :
Améliorer l’accès aux soins et lutter contre la pauvreté, 596 pages ;

Studies and official publications:

- Clément SORIAT (2021), Vers la santé pour tous en Côte d’Ivoire ? La Couverture
sanitaire universelle comme enjeu de redéfinition de l’État et de légitimation du
régime, 28 pages ;
- OMS (2015), Suivi des progrès vers ca couverture sanitaire universelle en Côte
d’Ivoire: Analyse situationnelle de base, 56 pages ;
- Jean Pierre SERY (2003), Suivi du développement des mutuelles de santé en
Afrique: actualisation de l’inventaire, cas de la Côte d’Ivoire, 26 pages ;
- SCIENCES PO PARIS (2017), Le droit à la santé en Côte d’Ivoire : état des lieux,
44 pages ;
- Dr N’DRI YOMAN (2008), Comment se soigne-t-on aujourd’hui en Côte d’Ivoire,
12 pages ;
- MINISTRY OF HEALTH AND PUBLIC HYGIENE (2017), Rapport annuel sur
la situation sanitaire 2016, 378 pages

Thesis:
- Rongcheng GU (2012), Sinistralité en assurance santé : modélisation, estimation
et application, 130 pages ;
- NGOUNOU BAKAM Yves Ismael (2015), Modélisation pour la tarification en
assurance santé: cas du Cameroun, 100 pages

XI
 WEBOGRAPHY
- The life insurance market in French-speaking sub-Saharan Africa, (page consulted on
June 28, 2021 at 8:08 p.m.) [Online], URL:https://www.cairn.info/revue-techniques-
financieres-et-developpement-2016-1-page-23.htm
- The Ivorian social security system, (page consulted on June 28, 2021 at 9:32 p.m.)
[Online], URL:https://www.cleiss.fr/docs/regimes/regime_cotedivoire.html
- The Ivorian health system, (page consulted on June 29, 2021 at 5:10 p.m.) [Online],
URL:https://www.goafricaonline.com/ci/articles/27-administration-sante-cote-ivoire
- Health in Côte d'Ivoire, (page consulted on September 16, 2021 at 2:03 p.m.) [Online],
URL:https://fr.wikipedia.org/wiki/Sant%C3%A9_en_C%C3%B4te_d%27Ivoire
- Organization of the health system in Côte d'Ivoire (page consulted on November 06,
2021 at 10:16 a.m.) [Online], URL:https://afrk50.com/l-organisation-du-systeme-de-
sante-en-cote-divoire/
- What solutions for the hospital system in Côte d'Ivoire?, (page consulted on November
22, 2021 at 9:18 p.m.) [Online],
URL:https://www.connectionivoirienne.net/2021/12/02/quelles-solutions-au-systeme-
hospitalier-en-cote-divoire/
- Côte d'Ivoire: 2021 ranking of insurance companies, page consulted on March 19, 2022
at 7:34 p.m.) [Online], URL:https://www.sikafinance.com/marches/cote-divoire-
classement-2021-des-societes-
dassurances_32631#:~:text=Le%20march%C3%A9%20ivoirien%20de%20l,9%20mi
lliards%20FCFA %20in%202020.
- Côte d'Ivoire: 2020 ranking of insurance companies, page consulted on March 19, 2022
at 7:38 p.m.) [Online], URL:https://www.sikafinance.com/marches/cote-divoire-
classement-2020-des-compagnies-dassurance_27133

XII
 TABLE OF CONTENTS
DEDICATION ....................................................................................................................... I
ACKNOWLEDGEMENTS ...................................................................................................... II
FOREWORD ...................................................................................................................... III
SUMMARY......................................................................................................................... V
LISTS OF TABLES ............................................................................................................... VI
LIST OF FIGURES ............................................................................................................... VI
LISTS OF DIAGRAMS ........................................................................................................ VII
LISTS OF PHOTOS ............................................................................................................. VII
ACRONYMS AND ABBREVIATIONS .................................................................................. VIII
ABSTRACT......................................................................................................................... IX
INTRODUCTION ................................................................................................................. 1
PART ONE: THEORETICAL CONTRIBUTIONS ........................................................................ 5
Chapter 1: Presentation of the health coverage system ............................................................. 6
Section 1: General information on health coverage .................................................................................... 6
Paragraph 1: History of health coverage ................................................................................................. 6
Paragraph 2: Evolution of health coverage in Côte d'Ivoire .................................................................... 7
1- Evolution of healthcare until 1978 ............................................................................................ 7
2- Evolution of care from 1978 ...................................................................................................... 7
Section 2: Health Insurance in Côte d'Ivoire ................................................................................................ 8
Paragraph 1: Principle and operation of complementary health insurance in Côte d'Ivoire .................. 8
1- Principle..................................................................................................................................... 8
2- How health insurance works ..................................................................................................... 8
a- The insurance company or the mutual ................................................................................. 8
b- The provider ......................................................................................................................... 8
c- Health Managers .................................................................................................................. 9
d- Repayment Terms................................................................................................................. 9
Paragraph 2: The structure of the health coverage system in CI............................................................. 9
1- The administrative slope ........................................................................................................... 9
2- The care offering side includes:............................................................................................... 10
a- The public sector ................................................................................................................ 10
b- The Private Sector .............................................................................................................. 11
c- Traditional Medicine........................................................................................................... 11
3- Forms of health coverage ........................................................................................................ 11
a- CMU: Universal Health Coverage ....................................................................................... 11
b- Additional coverage ............................................................................................................ 12
Chapter 2: Principle of the deferred financing health insurance product ...................................14
Section 1: Presentation of life annuity products ........................................................................................ 14
1- Definitions and Characteristics................................................................................................ 14
2- Types of life annuity products ................................................................................................. 15
a- Immediate life annuities ..................................................................................................... 15
b- Deferred life annuities ........................................................................................................ 15
c- Joint life annuity ................................................................................................................. 15
d- Tiered life annuity............................................................................................................... 15
e- Annuity with guaranteed annuities .................................................................................... 16
f- The annuity with long-term care guarantee ....................................................................... 16

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 3- Risks associated with life annuity type products..................................................................... 16
a- Longevity risk ...................................................................................................................... 17
b- Investment risk ................................................................................................................... 17
c- Interest rate risk ................................................................................................................. 17
d- Inflation risk ........................................................................................................................ 18
Paragraph 2: Reminders of some actuarial principles and Operation of life annuities ......................... 18
1- General .................................................................................................................................... 18
2- Reminders of actuarial principles ............................................................................................ 19
a- Deferred capital without counter-insurance ...................................................................... 19
b- The life annuity ................................................................................................................... 19
c- Case of the split annuity ..................................................................................................... 19
3- Notions of Prime Pure and loadings ........................................................................................ 20
a- The notion of Pure Premium .............................................................................................. 20
b- Loadings .............................................................................................................................. 21
c- Calculation of inventory and commercial premiums.......................................................... 22
Section 2: Similarities and Differences with Deferred Funding Health Coverage Product ......................... 23
Paragraph 1: Complementary retirement group contracts ................................................................... 23
1- Defined contribution pension contracts ................................................................................. 23
a- Object ................................................................................................................................. 23
b- Contributions ...................................................................................................................... 23
c- Management during the activity period ............................................................................. 24
d- Retirement management ................................................................................................... 24
2- Defined benefit retirement contracts ..................................................................................... 24
a- Object ................................................................................................................................. 25
b- Contributions ...................................................................................................................... 25
c- Management during the activity period ............................................................................. 25
d- Retirement management ................................................................................................... 25
Paragraph 2: Comparison with the deferred financing health insurance product ................................ 26
1- The commitments of the insured ............................................................................................ 26
2- The insurer's commitments..................................................................................................... 26

PART TWO: IMPLEMENTATION OF THE PRICING MODEL .................................................. 28

Chapter 3: Presentation of the stakeholders of the deferred financing health product. .............29
Section 1: Presentation of the different actors .......................................................................................... 29
Paragraph 1: The host structure: Leadway Vie ...................................................................................... 29
1- History of Leadway Vie, a subsidiary of Leadway Assurance Company .................................. 29
2- The subsidiary Leadway Vie .................................................................................................... 31
3- The subsidiary Leadway Assurance IARD ................................................................................ 33
4- Ankara Services ....................................................................................................................... 34
Paragraph 2: Analysis of the activity of Leadway Vie ............................................................................ 35
1- Savings products...................................................................................................................... 35
a- Presentation of savings products ....................................................................................... 36
b- Features of savings products .............................................................................................. 36
c- How Leadway Vie savings products work ........................................................................... 37
d- Mortgage ............................................................................................................................ 37
e- Conditions required for claims settlement ......................................................................... 38
2- Provident products .................................................................................................................. 38
a- Death Borrower .................................................................................................................. 38
b- Kanakassi ............................................................................................................................ 39
c- Leadway Lifestyle Protection .............................................................................................. 41
d- Leadway Group Welfare ..................................................................................................... 44
e- Leadway Souklou Protection .............................................................................................. 45
Paragraph 3: Definitions of the roles of each actor in the implementation of the product .................. 46
1- Leadway Vie ............................................................................................................................ 47
2- Leadway IARD .......................................................................................................................... 47
3- Ankara Services ....................................................................................................................... 47

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 Section 2: Presentation of Life Insurance on the Ivorian market ............................................................... 47
Paragraph 1: Definition of Insurance in the CIMA zone ........................................................................ 47
1- The CIMA area ......................................................................................................................... 47
2- Definition of Insurance ............................................................................................................ 49
3- Generalities ............................................................................................................................. 49
a- The insurability of risks ....................................................................................................... 49
b- Characteristics of an insurance contract ............................................................................ 49
c- Insurance Specifications ..................................................................................................... 51
4- Insurance in Côte d’Ivoire ....................................................................................................... 53
a- The Association of Insurance Companies of Côte d'Ivoire ................................................. 54
b- The main missions of the ASACI ......................................................................................... 54
5- Life Insurance in the CIMA zone .............................................................................................. 55
a- Definitions .......................................................................................................................... 55
b- Features of Life Insurance .................................................................................................. 56
Paragraph 2: Analysis of life insurance business in CI ........................................................................... 57
1- Life insurance in the event of death ........................................................................................ 57
a- The Term Life Insurance ..................................................................................................... 57
b- Survival Insurance ............................................................................................................... 57
c- Whole Life Insurance .......................................................................................................... 58
2- Life insurance in case of life .................................................................................................... 58
a- Deferred capital insurance ................................................................................................. 58
b- Annuity insurance in the event of life ................................................................................ 59
c- Immediate annuity insurance ............................................................................................. 59
d- Mixed insurance ................................................................................................................. 59
e- regular mixed...................................................................................................................... 60
f- Fixed term insurance .......................................................................................................... 60
Chapter 4: Pricing Model for Deferred Health Coverage for Retirees .........................................61
Section 1: Building the model .................................................................................................................... 61
Paragraph 1: Descriptive analysis of the data ....................................................................................... 61
1- The portfolio of the mutual ..................................................................................................... 61
2- Database layout....................................................................................................................... 62
3- Adjustment of certain variables and Supplements ................................................................. 62
4- Market health products........................................................................................................... 63
a- Company A ......................................................................................................................... 63
b- Company B.......................................................................................................................... 64
c- Company C.......................................................................................................................... 65
d- Company D ......................................................................................................................... 66
e- Company E .......................................................................................................................... 67
f- Company F .......................................................................................................................... 68
g- Company G ......................................................................................................................... 69
5- Claims rates ............................................................................................................................. 70
a- Description of the data used .............................................................................................. 70
b- Curve of claims rates by family of medical procedures ...................................................... 71
6- Mortality tables ....................................................................................................................... 77
Paragraph 2: Determination of the Net Premium of health coverage for retirees of Mutual X............ 77
1- Benefits table and Basic premium........................................................................................... 77
a- Base bonus obtained from company E ............................................................................... 79
b- Base bonus obtained from Company A .............................................................................. 80
c- Base bonus obtained from Company F............................................................................... 80
d- Base bonus obtained from Company G .............................................................................. 80
2- Application of claims rates per medical procedure and determination of the Net Annual
Premium ........................................................................................................................................... 81
a- Inflation rate assumption ................................................................................................... 83
b- Net Annual Premium .......................................................................................................... 83
Paragraph 3: Determination of Present Values of benefits and contributions per individual .............. 84
1- Present Values ......................................................................................................................... 84

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 2- Contributions........................................................................................................................... 85
Section 2: Presentation of the results ........................................................................................................ 87
Paragraph 1: Summary of benefits and contributions on the whole portfolio ..................................... 87
Paragraph 2: Methods of financing the savings fund ............................................................................ 87
1- Individually funded formula .................................................................................................... 87
2- Corporate financing formula ................................................................................................... 88
3- Block-funded formula.............................................................................................................. 88
CONCLUSION ................................................................................................................... 89
BIBLIOGRAPHY ................................................................................................................. XI
WEBOGRAPHY ................................................................................................................. XII
TABLE OF CONTENTS ...................................................................................................... XIII

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