The onset of the COVID-19 pandemic has had numerous impacts on health systems worldwide, with extra support needed globally to address the healthcare needs associated with the pandemic. One of the impacts of the pandemic has been a reduction in non-COVID healthcare activity, particularly due to restrictions on movement, or “lock-downs”, introduced to varying degrees worldwide in an effort to reduce the spread of the virus. In many markets, this has resulted in reduced levels of health insurance claims relative to a more “normal” year, as both elective healthcare services have been suspended and patients are generally reluctant to seek healthcare. In addition, changes to supply-side capacity have had an impact on claims. All these factors have introduced challenges for health insurers in terms of predicting future health insurance claims and therefore challenges for governments and national agencies responsible for the operation of risk equalisation schemes that are common features of many health insurance markets. In this report we look at the impact of COVID-19 on risk equalisation schemes in several countries and consider, what, if any, retrospective adjustments are available to address any related challenges arising from the pandemic.