Risk Scoring in Health Insurance: A Primer

Risk Scoring in Health Insurance: A Primer

The Society of Actuaries is pleased to make available a research report that provides a detailed explanation of the first stage of a risk adjustment program - the risk score model. This is also referred to as “risk scoring”. The report discusses the history and considerations related to risk scoring beyond its application in the ACA context.  The material was authored by Geoffrey Hileman, Syed Mehmud, and Marjorie Rosenberg.

If you have comments or questions, please contact Steve Siegel, Research Actuary at ssiegel@soa.org.

The SOA would like to thank the following members of the project oversight group for their review and support of the project:

  • John Bertko 
  • Kristi Bohn 
  • Cabe Chadick 
  • Ian Duncan
  • Rafi Herzfeld
  • David Knutson 
  • Rick Lassow
  • Tom Messer
  • Bernie Rabinowitz
  • Rebecca Owen, SOA Health Research Actuary
  • Steve Siegel, SOA Research Actuary
  • Joe Wurzburger, SOA Health Staff Fellow
  • Barbara Scott, SOA Research Administrator

Thanks to Veronika Badurova, Dave Kennell, and Spenser Steele of Kennell and Associates for additional review and technical assistance.