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Health insurer financial model, built free.

A three-statement Excel model for a health insurer or managed care organisation, built from your own figures and checked to balance.

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  • Usually ready within the hour

We use generative AI in parts of our process, so mistakes can occur. Every model should be checked by a person before it is relied on. Read more

The business

Private health fund or managed care plan collecting premiums per member (hospital and extras cover; or commercial, Medicare Advantage and Medicaid plans) and paying hospital, medical and drug benefits, earning the gap between premium and benefits and management expenses.

See the sampleHow the model works

In short

  • 01

    Three linked statements

    Income statement, balance sheet and cash flow, linked in every period.

  • 02

    Valued two ways

    Discounted cash flow and trading multiples, side by side.

  • 03

    Monthly to annual

    Monthly, quarterly, half-yearly or annual periods, for up to 30 years.

  • 04

    Checked every period

    A Checks sheet shows the balance sheet balances and the cash reconciles.

The sample

The sample, as Excel draws it.

Built by the same system and checks as yours, on illustrative figures: every sheet as Excel draws it, or live.

Annual · 10 years · Low detail
Health insurer sample model.xlsx
The Summary sheet of the sample health insurer model

Illustrative figures: the sample describes no real business. The live preview shows values; your model’s Excel file has every formula.

How it works

How the model works for a health insurer.

  1. How it earns revenue3 formulas
    Premiums · All insurance lines
    Closing unearned premiumGross earned premiumshare of the yearDays of premium paid ahead
    Premiums · All insurance lines
    Closing membersOpening membersNet growth in members
    Premiums · All insurance lines
    Member monthsOpening membersClosing membersshare of the year
  2. What drives its costs3 formulas
    Claims and loss ratios · All insurance lines
    Closing exposuresOpening exposuresGrowth in exposures
    Claims and loss ratios · All insurance lines
    Gross claims incurredClaims reportedAverage claim size
    Claims and loss ratios · All insurance lines
    Claims reportedExposure-years (average exposures × years)Claim frequency (claims per exposure a year)
  3. What it invests in3 formulas
    Corporate fixed assets
    Capital expenditureRevenuefrom statementsCapex as % of revenueAdditional planned capex
    Corporate fixed assets
    DepreciationDepreciation of the opening asset baseDepreciation of new capex
    Corporate fixed assets
    Closing net book valueOpening net book valueCapital expenditureDepreciation
  4. How it is funded3 formulas
    Debt
    RepaymentsScheduled repaymentsPrepayments from an equity raise and the cash sweep
    Debt
    Closing balanceOpening balanceDrawdownsRepayments
    Debt
    Interest expenseOpening balanceAll-in interest rateshare of the year
  5. How profit becomes cash3 formulas
    Claims reserves · All insurance lines
    Claims paid on claims incurred since the start datePaid in the first year after being incurredPaid in the second yearPaid in the third yearPaid in the fourth yearPaid in the fifth yearPaid in the sixth yearPaid in years seven to ten
    Claims reserves · All insurance lines
    Closing outstanding claimsOpening outstanding claimsGross claims incurredfrom claims and loss ratiosClaims paid
    Claims reserves · All insurance lines
    Claims paidClaims paid on claims incurred since the start dateClaims paid from the opening liability
What it covers

22 parts, each one tested.

Every part is a tested building block with its own checks: yours is put together from the ones your business needs.

  • CPI forecastConsensus curve with long-run anchor
  • Operating expensesHeadcount build by function
  • Corporate costsFixed cost base indexed to CPI
  • Working capitalFull working capital
  • Income taxCorporate rate with tax losses
  • Corporate fixed assetsStraight-line over remaining life
  • DebtAmortising term loan
  • Equity raisingDistribution reinvestment plan
  • Dividends and distributionsPayout of net profit
  • Discounted cash flow valuationDCF on free cash flow to the firm
  • Multiples valuationEV / EBITDA multiple
  • Investment incomeAsset allocation × expected returnsReturns on the investment portfolio backing technical reserves and shareholders' funds.
  • Solvency capitalRisk charges buildRegulatory capital required (prescribed capital amount or solvency capital requirement) and the coverage held, driving dividends and raisings.
  • Key-metric summaryLast-twelve-month and run-rate metrics
  • Case selectionStackable stress toggles
  • Value per shareTreasury-stock method
  • Interest-rate forecastMarket forward curve
  • Enterprise value to equity bridgeNet debt at the valuation date
  • PremiumsMembers × premium per member per monthGross written premium and how it is earned over the cover period, leaving an unearned premium liability.
  • Claims and loss ratiosFrequency × severityClaims incurred on earned premium — attritional, large and catastrophe claims, or mortality and morbidity for life risk.
  • Claims reservesPayment patternOutstanding claims liability built from claims incurred, the payment pattern, discounting and the risk adjustment.
  • Acquisition and underwriting expensesExpense ratio on earned premiumCommissions, other acquisition costs and the underwriting expenses that make up the expense ratio.
Key numbers

The numbers it tracks.

  1. 01members
  2. 02premium per member
  3. 03benefits per member
  4. 04medical loss ratio
  5. 05management expense ratio
  6. 06net margin
  7. 07capital coverage
Used for

What it is used for.

Also used for
  • Scenarios and sensitivities
Related models

More in insurance.

Every financial services model

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See a finished model, sheet by sheet

The sample is built on illustrative figures and describes no real business. Models are calculations prepared from the information you provide. They are not financial advice and must be independently verified. See our terms.