Description: Disease management DM is increasingly encountered in health plans and employer groups as a health care intervention targeted to individuals with chronic diseases chronics. The untested assumption is that without DM, the chronic and non-chronic trends are identical. From Financing Chronic Care Monograph, M-HB05-1.

Description: Employer and payers need to actively seek change in the system of mental health care deliveryoperational, clinical, and financial change. From Financing Chronic Care Monograph, M-HB05-1.

Description: Essay reforming management in health care, structure of reimbursement, program management, health information, measurement systems, etc.

Description: This presentation, session number 97CS, took place at the 1999 Spring Meeting of the Society of Actuaries, held May 24-25 in Atlanta. Using a fictional case study of a class action market conduct related suit against a life insurance company, the presenters discuss the role of the actuary in identifying the problem, quantifying the exposure, and determining the financial consequences of any proposed settlement. Discussion from participants is included. From the Record of the Society of Actuaries, Vol. 25, No. 1.

Description: Essay where payers desiring to optimize health gains per dollar spent should avoid “across the board” cost sharing, and instead implement a “value based” design that removes barriers/provides incentives to encourage desired behaviors for patients and providers.

Description: AHIP commissioned the Menges Group to write this white paper on key pressures in the budgetary environment that stress the actuarial soundness of Medicaid rates. Though written by non-actuaries, this white paper thoroughly describes key professionalism topics that face Medicaid actuaries in their daily work.

Description: Basic Qualification of Life Insurance Contracts under the Internal Revenue Code

Description: The article summarizes and comments on a recent IRS Chief Counsel Advice that addressed how the proration formula works for purposes of the separate account dividends received deduction in the context of a partnership structure. The article explains the historical background of the proration formula as it appeared in the 1959 Act and the differences between how the applies and affects the dividends received deduction in the partnership structure versus the more tradition RIC structure.

Description: The article addresses the safe harbor guidance provided in Notice 2016-63 for 2017 CSO contracts satisfying the section 7702 reasonable mortality requirements

Description: This section presents and summarizes major insurance-related legal cases of 1957, including a case regarding interpretation of the Soldiers' and Sailors' Civil Relief Act of 1940 with amendments, FIT deduction of group disability benefits, FTC jurisdiction over advertising, group life employee ineligibility and incontestable clause, date of reinstatement, and claims issues.