DHA / DOH compatible · Standardized format

Drop a claims report. Get an underwriting brief.

Universal claims analyzer for UAE group medical. Reads any DHA-format claims report and produces an underwriter-ready brief in under a minute.

OR
⚙
Reproducible
Same inputs → same outputs. Every parameter and assumption is logged with full audit trail.
⚐
Anomaly detection
Sanity-checks claims data for incomplete months, mismatched totals, and tail-month drops.
⇄
What-if simulation
Live plan-design lever simulator. Adjust pharmacy co-ins, room category, network — see the premium move.
Workspace / Renewals 2026 / Sample Client L.L.C.
Hello Underwriter · welcome back

Sample Client L.L.C.

890 → 995 lives IT services Dubai · DHA May'25 → Feb'26 · 9.5mo Data quality 78/100
▤
Executive abstract
A 995-life IT services group (opening 890) with 9.5 months of claims experience. Annualized burning cost lands at — (—), computing…. No catastrophic clinical signals in the top-10 diagnosis groups (32.7% of value — full catastrophe screen requires claimant-level data). Two items earn the underwriter's attention: pharmacy share at 23.9% approaching the soft threshold, and out-of-network unit cost 3.1× in-network on a small but concentrated leakage. Data integrity is reasonable but not clean — reported IBNR appears light, the tail month under-developed, and 2.5 months of the policy year remain unobserved. Indicative gross at current parameters: —. Recommended next step: request the missing months and a member-level claims listing, pin parameters, and walk through the plan-design simulator with the broker.
◐
Ultimate claims
AED3.97m
full credibility
◢
Burning cost
AED3.82m
— · — vs prior-yr report
◇
Indicative gross premium
AED4.78m
— · excl. VAT & levies
◆
Data quality
78/ 100
⚑ 3 watchpoints
Per-life figures on midpoint exposure basis (942.5 exposed lives — opening 890 / closing 995 per DHA census). Premiums excl. VAT & statutory levies.
Case outputs
02 · Data quality

Data integrity check

Automated sanity checks on the source claims report. Yellow items are noted and typically tolerable; green indicates clean data; grey marks checks the aggregate DHA format cannot support.

—
◌
Claimant-level check — not assessable Scope
Source report is aggregate-only (DHA mandated format) — no member-level claim listing. Top-claimant concentration and single-event large losses cannot be screened from this file.
Request member-level claims listing →
⚐
Incomplete observation period Coverage
Only 9.5 months of the policy year provided (May'25 → Feb'26). 2.5 months remain unobserved. Annualization assumes the unseen months track selected-month average.
Request remaining months →
⚐
Tail-month under-development Reserving
February paid claims dropped to AED 221,513, roughly 43% below the selected-month average of AED 386,641. Likely incomplete processing at report cut-off. Auto-excluded from run-rate; can be re-included via month chips.
⚐
IBNR reserve appears light Reserving
Reported IBNR is 0.5% of processed claims; market median for a 9.5-month tail is 4–7%. Combined RBNP+IBNR (AED 296,136 · 8.3%) is below typical 10–15%. Run-rate carries an adjustable IBNR top-up in Parameters; adequacy not conclusively assessable without development triangles.
✓
No catastrophic clinical signals in scope Clinical
No malignancy, dialysis, or transplant activity in the top-10 diagnosis groups (32.7% of processed value). Full catastrophe screen requires claimant-level data.
◌
Fraud-pattern screen — not assessable Scope
Requires claim-line dates and member-level frequency, neither of which the aggregate report carries. No screen performed.
✓
Source totals reconcile Integrity
Sum of monthly paid claims equals the header total AED 3,547,493 exactly (0.00%). Top-10 diagnosis groups account for 32.7% of processed value — consistent with a top-10-only DHA extract.
✓
Demographic coverage complete Census
All 995 closing lives mapped to DHA age band × marital status. Nationality per census file (98% coverage). Sufficient for one-way pricing cross-check.
03 · Claims

Claims overview

Over 9.5 months the group incurred AED 3.55m processed with light reserves (total incurred AED 3.84m), projecting to an annualized burning cost of —. Two items are notable.

Processed claims Source report
3,547,493
Reserves (RBNP + IBNR) Source report
296,136 · 8.3% (light)
Total incurred
3,843,629
Annualized burning cost
4,639,686
Pharmacy share ?
23.9% · watch
Out-of-network share
4.6% · avg 3.1× in-net
Catastrophic signals (top-10 dx scope)
None in scope

By service category

Outpatient
53.9%
Pharmacy
23.9%
Inpatient
21.2%
Dental
0.9%
Optical
0.1%
04 · Monthly

Monthly claims

Toggle months to include in the run-rate calculation. Defaults exclude the partial first month (policy incepts 15-May) and the under-developed tail (Feb'26). Every figure on this page updates live as you change the selection.

8 of 10 months · annualized ×12
Selected sum
AED 2.55m
Annualized
AED 3.82m
Monthly avg
AED 319k
Months
05 · Comparison

vs prior year · book · market

Three independent reference frames. Prior year shows how this group is trending against itself; book benchmark is the insurer's expectation for similar IT/Tech groups; UAE market uses DHA-published industry norms.

Metric FY25 prior-yr report on file FY26 (current) Book benchmark Book table UAE market Market estimate Verdict
Burning cost (PPPY, ERP basis) 3,610 — 4,680 4,420 —
Pharmacy share 21.0% 23.9% 22.0% 23.5% —
Out-of-network share 4.2% 4.6% 5.5% 6.0% —
Avg claim size (AED, paid basis) 368 — 410 395 —
Maternity share of value 2.6% — 3.0% 3.2% —
Diabetes share of value model estimate 4.4% — 5.5% 6.0% —
Claim frequency (per 1k lives, ERP) 8,720 — 8,100 8,500 —
Lives (opening → closing) Source report 890 995 — — +11.8% growth
06 · Clinical

Top ten diagnoses

Automated clinical commentary — pattern-based; requires clinical review before client use. Flagged rows (⚑) are conditions the underwriter should actively consider — either because they carry forward-year escalation risk, or because they drive current pricing.

No malignancy / dialysis / transplant in top-10 groups (32.7% of value)
Diagnosis Value Count Avg Trend illustrative Automated note
⚑
Other dorsopathies Chronic
196,608309636
Back & musculoskeletal. High frequency, moderate severity.
—
Acute upper respiratory Acute
192,5891,182163
Cold/flu. Volume driver, not cost driver.
⚑
Diabetes mellitus Escalating
186,809288649
288 diabetes-related claim lines (not member prevalence). UAE prevalence ~19% market estimate. CDM enrollment recommended.
—
Acute lower respiratory Acute
100,802419240
Pneumonia/bronchitis. No escalation pattern in-period.
⚑
Other joint disorders Chronic
92,257311297
Arthropathies. Steady cost curve.
—
Female genital tract Gynae
84,130254331
Routine gynae. Expected for the married-female cohort.
⚑
Urolithiasis Recurrent
83,194651,280
Kidney stones. Hydration program is the lever.
—
Maternity care Expected
78,405203,920
20 maternity claim lines (~4–5 estimated deliveries; claims ≠ deliveries).
—
Circ./resp. symptoms Workup
73,791386191
Diagnostic workups. 100% outpatient. Benign.
—
Shoulder/upper arm injury Injury
72,070292,485
Sport/accident. Isolated events.
07 · Providers

Where care happens

Top providers by spend share. vs Book compares this group's average claim at the provider against the book average for the same provider. Values above 1.0× indicate higher-than-expected billing.

Provider Share Value Visits Avg claim vs Book
Zulekha Hospital · Nahda Dubai
180,8701989130.96×
NMC Specialty · Nahda Dubai
150,7091579600.98×
NMC Specialty · Electra AD
118,2062065740.88×
NMC Royal · Sharjah
106,5691308201.22×
Zulekha · Sharjah
80,135101793—
Emirates Specialty · DHCC
76,6831525041.58×
Aster · Mankhool
70,1132133290.91×
Al Sharq · Fujairah
48,52793522—
Prime · Garhoud
47,994104,7991.28×
Aster · Silicon Oasis
39,5052391650.94×
08 · Census demographics

Who's in the group

Age, gender and marital splits come from the DHA closing census in the source report; composition and forward-year risk pools come from the uploaded census file (986 lives) — each panel is tagged with its source.

Gender mix Source report
Male
599
60.2%
Female
396
39.8%
Female marital status Source report
Single F
149
37.6%
Married F
247
62.4%
Composition Census file · 986 lives
Employees
558
56.6%
Spouses
179
18.2%
Children
249
25.3%
Age distribution — DHA bands × sex Source report
0–15
244
24.5% · M 130 / F 114
16–25
38
3.8% · M 22 / F 16
26–35
383
38.5% · M 219 / F 164
36–50
313
31.5% · M 216 / F 97
51–65
17
1.7% · M 12 / F 5
65+
0
—
Forward-year risk pools Census file · model estimate
▲
Maternity-eligible cohort: 138 members — married females 18–40 per census file. At a market rate of ~4.5%/yr, expect ~6 deliveries. Observed: 20 maternity claim lines (~4–5 estimated deliveries; claims ≠ deliveries).
▲
Chronic-prone cohort (40+): 188 members per census file. Diabetes/hypertension prevalence typically rises ~3× in this band — forward-year watch item alongside the 288 diabetes claim lines observed.
●
Dependent ratio: 0.27 (428 deps / 558 emps per census file — family-count basis 0.27 per employee-family) — below market (typical UAE IT 0.4–0.6).
●
Pediatric band (0–15): 244 members per DHA census — well-baby visit patterns and DHA vaccination schedule apply.
09 · Nationality

Nationality mix

Nationality is an independent predictor of cost in UAE group medical. Cross-referencing the group's mix (census file) against the one-way rate table gives a sanity check independent of claims experience — computed live from the table below.

NationalityLivesShareExpected PPPY
INIndian
617
3,820
PKPakistani
149
3,560
PHFilipino
80
3,120
EGEgyptian
50
5,240
LKSri Lankan
30
3,440
LBLebanese
30
8,100
AEUAE National
20
9,450
··Other
19
3,600
Sanity check Census file × one-way rate table

Expected PPPY purely from the nationality mix is —. Actual claims-driven PPPY (annualized, ERP basis) comes in at — — — vs nationality-predicted.

Nationality-predicted PPPY
—
Actual — · delta —
10 · Plan design

What-if simulator

Adjust benefit-design levers and watch the premium move. Applies market-standard elasticity assumptions to this group's actual service-mix weights — constants shown in the ⓘ methodology. Combined levers compound multiplicatively. Current-plan baselines are from the incumbent TOB upload.

Plan-design what-if Live baselines: incumbent TOB
Total simulated saving: AED 0 · 0.0%
Pharmacy co-insurance
Current 10% → 10%
Estimated saving: AED 0
OON co-insurance
Current 20% → 20%
Estimated saving: AED 0
Specialist GP-referral gate
Current Off → Off
Estimated saving: AED 0
Room category
Current Private → Private
Estimated saving: AED 0
Network tier
Current Tier 1 → Tier 1
Estimated saving: AED 0
Dental annual cap (AED)
Current 1,000 → 1,000
Estimated saving: AED 0
Baseline burning cost
AED 3.82m
Pre-simulation
Simulated burning cost
AED 3.82m
no levers active
Simulated gross premium
AED 4.78m
PPPY 4,802
11 · Broker scenarios

Impact calculator

Pre-computed scenarios for broker conversations. Premium impact is shown as the percentage change vs the baseline gross premium and the absolute AED amount. Useful for quick "what if we changed X?" questions.

Common broker scenarios
Baseline: AED 4.78m · PPPY 4,802
Scenario New premium Δ AED Δ %
12 · Levers

Directional levers

Angles to consider — not prescriptions. Savings ranges are indicative; the underwriter decides what fits the client, retention, and renewal dynamics.

Tighten out-of-network unit cost
OON sits at 4.6% of value but carries an average claim 3.1× in-network. Two top OON providers fall outside the managed network. Cost-control angles: reimbursement review, emergency-only carve-outs, or migration to an equivalent managed network.
OON access can be retention-sensitive, especially for senior cohorts.
Indicative
80–120k
50–75% of OON
High
Chronic disease management
58 active diabetes cases (+38% YoY) and persistent dorsopathies cohort. Structured CDM programs typically reduce downstream acute episodes; formulary discipline on maintenance medications compounds the effect.
Benefit-positive lever — usually easy to sell at renewal as an enhancement rather than a cut.
Indicative
80–160k
on chronic block
Medium
Control pharmacy drift
Pharmacy at 24% of spend, up from 21% prior year. Approaching the 30% soft threshold. Standard interventions: formulary discipline, generic-first substitution, cap review.
Exempt chronics via CDM — blanket cap enforcement hurts the sickest and triggers retention risk.
Indicative
85–170k
10–20% of pharmacy
Medium
Right-size dental limit
Dental spend is AED 32k / 0.9%; only ~23% member penetration against AED 1,000 limit. Either over-sized or poorly communicated. Rightsize or promote — direction depends on client priorities.
"Under-used" sometimes reflects awareness gaps, not over-provision. Check with HR before cutting.
Indicative
25–50k
premium pass-through
Low
13 · Pricing anchors

Reference premiums

Four anchors. Claims-rated comes live from experience and parameters. Comparable portfolio is auto-calculated from the book table × the DHA closing demographic. Demographic & benefit-rated is an underwriter input. The technical indication is a predictive blend of the other three.

These are reference anchors, not pricing recommendations. The underwriter makes the call; the tool shows the spread.
Claims-rated premium AutoBased on the group’s own claims experience
—PPPY —
Comparable portfolio premium AutoBased on similar groups in the insurer’s portfolio
—PPPY —
Demographic & Benefit-Rated Indication EditExpected cost based on demographics and plan design
Underwriting.ae Technical Indication Auto · predictive blend v0Predictive indication combining claims, census, benefits and portfolio patterns
—PPPY —
Spread (low → high)
—AED
Current indication
—Claims-rated (underwriter-selected)
Per-life basis
Midpoint exposure (ERP 942.5)
Pricing settled? Generate the quotation — it opens pre-calibrated to the indicative gross premium above, split by age band and employee/dependent. Audit log captures every change.