What action must an insurer take if 15 out of 50 members in a group health policy have major health issues?

In the context of group health insurance, insurers often evaluate the overall risk posed by a group. When a significant number of members, such as 15 out of 50, present major health issues, the insurer must make a critical decision about the entire group rather than individual members.

Accepting or rejecting the whole group allows the insurer to assess the risk in a holistic manner, taking into account the collective health of all members. This is in line with the principles governing group health insurance, where the risk is pooled among all members rather than evaluated on a singular basis. If the risk is deemed too high, insurers may opt to not cover the group at all, which is common if the health issues create an unsustainable financial risk.

The other options do not align with standard practices in group health insurance. Providing coverage for health issues would not address the larger concern of overall group risk. Increasing premiums could happen in some individual cases, but typically not solely for severely affected members because it conflicts with the nature of group insurance. Excluding affected members would be counterproductive as group policies generally cover all members rather than selectively underwriting individuals.