Joint Life Long-Term Care Insurance: A Semi-Markov Multi-State Model Integrating LTC Prevalence and Mortality Trends

Roro Anteng, Adhitya Ronnie Effendie

Abstract


This study develops a two-person joint-life long-term care (LTC) insurance pricing framework for married couples by incorporating mortality and LTC risks within a semi-Markov-inspired multi-state model. The transition intensity structure accounts for Gompertz mortality, potential common-shock events, and a duration-dependent bereavement effect. LTC-related transition intensities are adjusted using proportional factors, while the transition probabilities are approximated using a matrix-exponential procedure and applied to the calculation of net single premiums.A numerical case study is presented for a married couple aged 62 and 60 under a 20-year coverage period. The alternative benefit designs include mortality protection, LTC annuity protection, and a combined design integrating death and LTC benefits. The results indicate mortality dependence between spouses through the common-shock and post-bereavement mechanisms and show that broader benefit coverage produces a higher net single premium.The main contribution of this study is an actuarial pricing framework for two associated individuals that jointly incorporates spousal mortality dependence, LTC incidence, and combined death and LTC benefits in a unified multi-state structure.


Keywords


Semi-Markov multistate models; Long-Term Care (LTC) Insurance; Joint Contract; Premium Calculation

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References


M. Arntz, R. Sacchetto, A. Spermann, S. Steffes, and S. Widmaier, “The German Social Long-Term Care Insurance: Structure and Reform Options,” Centre for European Economic Research (ZEW), Tech. Rep. 0625, 2007, doi:10.2139/ssrn.944780.

S. Xuanyuan and S. Xuanyuan, “Application of Markov Model in Long-Term Care Insurance,” Highlights in Science, Engineering and Technology, vol. 47, pp. 9–15, 2023, doi:10.54097/hset.v47i.8156.

T. R. Lambregts and F. T. Schut, “Displaced, Disliked and Misunderstood: A Systematic Review of the Reasons for Low Uptake of Long-Term Care Insurance and Life Annuities,” The Journal of the Economics of Ageing, vol. 17, p. 100236, 2020, doi:10.1016/j.jeoa.2020.100236.

R. T. Konetzka, Long-Term Care Insurance, 1st ed. New York, NY: Elsevier, 2014, doi:10.1016/B978-0-12-375678-7.01002-6.

American Association for Long-Term Care Insurance, “Saving Strategies for Couples Age 60: 2019 Price Index,” 2019.

J. R. Brown and A. Finkelstein, “Why Is the Market for Long-Term Care Insurance So Small?” NBER Working Paper Series, vol. 91, pp. 1967–1991, 2007, doi:10.1016/j.jpubeco.2007.02.010.

Kementerian Kesehatan Republik Indonesia, “Indonesia Masuki Periode Aging Population,” Jul. 2019, published July 4, 2019.

S. Haberman and E. Pitacco, Actuarial Models for Disability Insurance, 1st ed. Florida: CRC Press, 1999, doi:10.1201/9781315136622.

C. P. Gumauti, Y. Wilandari, and R. Rahmawati, “Perhitungan Premi Asuransi Long Term Care untuk Model Multi Status,” Jurnal Gaussian, vol. 5, no. 2, pp. 259–267, 2016, doi:10.14710/j.gauss.5.2.259-267.

M. Ji, “Markovian Approaches to Joint-Life Mortality with Applications in Risk Management,” Ph.D. dissertation, University of Waterloo, Waterloo, Canada, 2012.

D. C. M. Dickson, M. R. Hardy, and H. R. Waters, Actuarial Mathematics for Life Contingent Risks, 2nd ed. New York, NY: Cambridge University Press, 2009.

P. Zweifel, “Innovation in Long-Term Care Insurance: Joint Contracts for Mitigating Relational Moral Hazard,” Insurance: Mathematics and Economics, vol. 93, pp. 116–124, 2020, doi:10.1016/j.insmatheco.2020.04.002.

M. Ventura-Marco, C. Vidal-Meliá, and J. M. Pérez-Salmero González, “Joint Life Care Annuities to Help Retired Couples to Finance the Cost of Long-Term Care,” Insurance: Mathematics and Economics, vol. 113, pp. 122–139, 2023, doi:10.1016/j.insmatheco.2023.08.002.

M. Ji and R. Zhou, “A General Semi-Markov Model for Coupled Lifetimes,” North American Actuarial Journal, vol. 23, no. 1, pp. 98–119, 2019, doi:10.1080/10920277.2018.1513370.

M. Ji, M. R. Hardy, and J. S. H. Li, “Markovian Approaches to Joint-Life Mortality,” North American Actuarial Journal, vol. 15, no. 3, pp. 357–376, 2011, doi:10.1080/10920277.2011.10597625.

J. H. Fong, A. W. Shao, and M. Sherris, “Multistate Actuarial Models of Functional Disability,” North American Actuarial Journal, vol. 19, no. 1, pp. 41–59, 2015, doi:10.1080/10920277.2014.978025.

Q. Shang, X. Wang, X. Qin, and X. Zhao, “Pricing of Joint Life Long-Term Care Insurance Based on a Multistate Markov Model,” North American Actuarial Journal, vol. 28, no. 2, pp. 361–372, 2024, doi:10.1080/10920277.2023.2208192.

Q. Guibert and F. Planchet, “Non-Parametric Inference of Transition Probabilities Based on Aalen–Johansen Integral Estimators for Acyclic Multi-State Models: Application to LTC Insurance,” Insurance: Mathematics and Economics, vol. 82, pp. 21–36, 2018, doi:10.1016/j.insmatheco.2018.05.004.

Institute of Actuaries, “Equity Release Report 2005, Volume 2: Technical Supplement: Pricing Considerations,” Institute of Actuaries, Tech. Rep., 2005.

S.-Z. Yu, Hidden Semi-Markov Models: Theory, Algorithms and Applications. Netherlands: Elsevier Science Publishers B. V., 2015.

M. Fuino and J. Wagner, “Long-Term Care Models and Dependence Probability Tables by Acuity Level: New Empirical Evidence from Switzerland,” Insurance: Mathematics and Economics, vol. 81, pp. 51–70, 2018, doi:10.1016/j.insmatheco.2018.05.002.

Society of Actuaries, “2000–2016 Long-Term Care Aggregated Databases,” 2016.




DOI: https://doi.org/10.37905/jjom.v8i2.39021



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