Description: Feature article discussing the impact of health care reform on the direct insurance market and the reinsurance market.

Description: The discussion will review major elements of the reinsurance market as health care reform replaces traditional markets. From Record of Society of Actuaries Vol. 20, No. 3A.

Description: LEARN is an offering to regulators about reinsurance. This article summarizes a session held for Brazilian health regulators in the fall of 2022.

Description: To inform and educate stakeholders for health plans and insurers on novel ways to optimize reinsurance structures to meet capital related goals and boost RBC and liquidity ratios. In lieu of traditional market-based financial instruments involving equity and/or debt, a quota share transaction can be used with potentially far more attractive terms and achieving essentially the same result.

Description: Cell and Gene Therapy (CGT) are life-changing treatments where conditions such as cancer, hemophilia, spinal muscular atrophy and blindness are being cured. These are great for individuals and society, but the treatment costs are expensive which is bad for payers and reinsurers. This article explores ways for health reinsurance actuaries to participate in the space and evaluate the risk associated with these treatments

Description: Gathering information and assess risks of Managed Care Networks. Looking at cost and service areas. Issue No. 44.

Description: This article attempts to make a modest contribution to the dialogue on the potential and risks associated with novel treatments such as cell & gene therapies. With a fast-expanding roster of what are believed to be one-time treatments at ever increasing price points aimed at curing a wider swatch of the population, they are as much a source of relief for patients stuck in medical limbo, as they are a source of anxiety for payers.

Description: The purpose of this SOA-sponsored research was to assemble and analyze a limited large claims database which may serve as a model for expanded inter-company studies of health care benefits in the future. From Group Medical Insurance Large Claims Database Collection and Analysis, M-HB97-1.

Description: This article enumerates many important considerations for a managing general underwriter(MGU) desiring to contract with an insurance carrier to issue and service provider excess of loss policies covering catastrophic medical risks assumed by accountable care organizations (ACOs).

Description: Panelists discuss the following managed care topics: · Design issues/pros and cons e.g., self-directed health-care model · Provider reimbursement methodologies · Consumer and regulatory issues · Insurance and reinsurance pricing and underwriting issues · Catastrophic claims · Risk-based capital repercussions · Defined contribution health plans From the Record of the Society of Actuaries, Volume 27, No. 1, Session 61