North Carolina Accident and Health Practice Exam

The correct answer highlights that the loss ratio is a crucial metric for health insurance providers because it measures the percentage of premiums that are spent on paying claims. This ratio is typically calculated by dividing the total amount of claims paid by the total premiums collected over a certain period. A higher loss ratio indicates that a significant portion of the premiums is being used to cover claims, which can inform the insurer about their risk management and pricing strategies.

Understanding the loss ratio is essential for health insurance companies since it directly impacts their profitability and sustainability. If the loss ratio is too high, it may indicate that the insurer is not charging enough in premiums to cover the costs of claims, which could lead to financial instability. Conversely, a low loss ratio might suggest that an insurance provider is pricing their products too high or that they are effectively managing claims, which can be beneficial for their overall financial health.

The other options relate to different aspects of insurance operations but do not directly define the loss ratio's role. For instance, deductibles are determined by policy design rather than loss ratios, claims processing efficiency pertains to operational performance, and the number of providers in a network is influenced by negotiations and market dynamics rather than loss metrics. The loss ratio specifically focuses on the financial relationship between claims