Description: Gross premium calculation methods may be arbitrarily separated into: a- Type 1 methods those which initially have commissions and other per cent of premium expenses in the denominator and b- Type 2 methods those which initially have commissions and other per cent of premium expenses in the numerator. The traditional Type 1 methods directly calculate the gross premium. The purpose of this paper is: 1. to present a Type 1 method of gross premium calculation which does the following: a Incorporates the cost of reinsurance into the gross premium calculation and may be shown as a level annual cost over the gross premium calculation period. b Calculates the effect on profit margins of a change in the retention limit without redoing the original calculation. c Calculates the premiums needed to break even e.g., amortize the initial investment in surplus at the end of each policy year as a by-product. d Calculates the profit or loss generated in each policy year or over any number of policy years for any gross premium without redoing the original calculation or first using a trial gross premium. e Directly solves for the gross premium that will produce any specified profit over any number of policy years without redoing the original calculation or first using a trial gross premium. f Directly solves for the premium that will produce a specified yield on surplus invested in new business by a flexible technique not first involving the use of the renewal net premium or any other preliminary gross premium. 2. to provide a mathematical definition of a financially meaningful average policy size which recognizes the cost of reinsurance. 3. to provide for mathematical definitions of common measures of profit, and the mathematical relationships between them. 4. To establish formulas expressing the effect of changes in various assumptions used in the gross premium calculation as a lev

Description: Relative to group medical plans, discusses: recognition given to effect on morbidity of various demographic factors, consideration given to inflation in making rate guarantees, consideration given to group size, and underwriting transfer cases.

Description: This report compares health care utilization and expenditures between individuals with Crohn’s disease who had used infliximab and those who had not. Claims data from the 1999-2003 Thomson Reuters MarketScan commercial claims and encounters databases and inpatient, outpatient, and prescription drug claims data of individuals older than 18 years of age with a diagnosis of Crohn’s were included.

Description: This paper describes an actuarial methodology [adjusted average per capita cost - AAPCC] developed to meet the requirements of the risk contract that the medicare program makes available to certain health maintenance organizations. From Transactions of Society of Actuaries 1981, Vol. 33.

Description: The primary objective of the paper was to develop a straightforward method for constructing an interpolation formula of finite range with desired properties stipulated in advance. This paper had in view mainly the application to polynomial interpolation as used in actuarial work. Followed by 2 discussion papers submitted

Description: The primary purpose of this paper is to present an alternative method of determining the profitability of the premium for a return of premium benefit through the use of a limited simulation program. Also discussed are necessary reserves for a return of premium benefit. From Transactions of Society of Actuaries 1973, Vol. 25, Pt. 1, No. 73.

Description: This paper presents an introduction to collective risk theory. In collective risk theory one seeks to investigate directly the risk enterprise as a whole. Primary interest is focused not upon the gains, losses, or claims from individual policies but upon the amount of total claims or the total gain arising from all the policies in the portfolio considered. Followed by several discussion papers submitted.

Description: This report is to estimate the burden of chronic disability on the U.S. elderly population, using unisex and sex-specific measures of long-term care service use, intensity and costs. It discusses disability prevalence, incidence, duration, and long-term care intensity and cost.

Description: Disease management [DM] is a health care intervention targeted to individuals with chronic diseases chronics. To justify the investment by payers in DM, it is important to demonstrate beneficial clinical and financial outcomes. This paper analyzes the health cost trends between the chronic and non-chronic populations. Paper 7 of an 8 paper series on 'An Introduction to Care Management Interventions and Their Implications for Actuaries'.

Description: This paper applies the principles and methodologies discussed in earlier papers in this series to measure cost savings from a two-year disease management DM program for the 200,000 Medicare members of a regional managed care plan. We then study how savings estimates change when we allow for four variations in key assumptions: methods for identifying or excluding plan members, requirements for eligibility in the health plan, methods for calculating health care trend and study design. Finally, we also examine the sensitivity of these results to product type by comparing the Medicare results to those of the Commercial HMO/POS product. Paper 8 of an 8 paper series titled: “Evaluating the Results of Care Management Interventions: Comparative Analysis of Different Outcomes Measures” sponsored by the Society of Actuaries’ Health Section and the Committee on Knowledge Extension Research.