Description: The Health Section Research Team is pleased to make available the following research study and Excel model that provide a framework for estimating the financial impact of health plan provider network risk. The research was conducted by the Denver office of Milliman, Inc. The Excel workbook allows the user to assess cost implications of aspects of network risk under various assumptions. The assumptions in the workbook can be altered by the user and be applied to test a range of scenarios.

Description: This presentation on the subject of Defined-Contribution Health Plans, covers reasons to move to a DC health plan, advantages and disadvantages, comparison to DC retirement plans, plan designs, pricing, risk considerations, and the regulatory and tax environment. 2001 SOA Annual Meeting, New Orleans.

Description: This report describes the results of a survey on reflecting risk in pricing. The survey expands on one conducted in 2003 and was expanded to include life, health, P&C, and non-North American insurance companies.

Description: This 1978 panel discussion is about personal casualty lines on a group basis. It focused on: 1. The traditional approaches of group life and health versus individual policies for fire and casualty 2. Problems in product design and underwriting, and 3. The impact of federal income tax laws. 4. Regulatory constraints. The discussions were primarily on personal automobile insurance.

Description: The article documents the efficacy of infra-low frequency neurofeedback regarding how it improves patient no show rates, decreases mental health symptoms by 40% or more, and self-harm and suicidal ideations.

Description: This article describes Medicare Supplement and short-term care products in more detail, and we compare their risk profiles. We explore the concept that these two products—when offered together—may provide a complementary hedge of certain policyholder behavior risks.

Description: This article provides an overview of critical illness insurance: history, product description, and the three primary ways to offer critical illness coverage in the United States. This article also contains an illustration of an issue age premium rate calculation, as well as product features and rating applications specific to the various types of critical illness coverage.

Description: It is the purpose of this paper to provide data derived from actual claim experience on lives age 65 and over in a form that will facilitate actuarial calculations involving modification of durations of hospital stay and variations in the allowances provided for miscellaneous services billed by the hospital. From Transactions of Society of Actuaries 1963, Vol. 15, pt. 1, No. 43.

Description: The focus of this article is to provide background to actuaries on the updates in the employer stop loss medical insurance market including underwriting and pricing trends.

Description: This chapter focuses on creating practical models that aid in the prediction of the risk of readmission to a specific hospital within 30 days of discharge for Medicare patients, to aid in the identification and stratification of at-risk patients for hospitals considering building an intervention program in a cost-effective manner. For readers who wish to develop their own predictive model, a dataset is provided on the Actexmadriver.com website, and R code is provided in the appendix to this chapter.