Description: This session at a SOA 1990 Spring Meeting is about open ended managed care plans from various perspectives including structure, marketing and actuarial issues.

Description: In Medicaid rate development, actuaries have not historically shared models that developed the margin (i.e., underwriting gain) assumption. This is unfortunate, given the margin assumption is one of the most critical components of the rate development in ensuring financial solvency of the Medicaid managed care organizations (MCOs). In this session, we will discuss the primary components of the this assumption and will share working models that help actuaries quantify these components—including the cost of capital and risk (or contingency) margin. We expect a lively discussion as we “open the black box” and discuss these actuarial assumptions in the public for the first time.

Description: This 1981 session dealt with individual accident and health rate regulation issues. Topics included the history of regulations and their primary purpose or need. From Record of Society of Actuaries, Vol. 7, No. 2.

Description: Panelists at this session of the SOA 2001 Annual Meeting discuss pricing issues and business risks associated with life, annuity, medical expense and disability income insurance products and compare them to long-term care [LTC].

Description: The presenters will provide insights into fraud and abuse risk in the health insurance industry, including an examination of traditional and predictive modeling techniques for both prevention and detection. Emphasis will be placed on current and emerging risks. Canadian examples and perspectives will be offered, but the applications for attendees to use in practice are non-nation specific.

Description: This discussion is on the availability of utilization and cost experience data for group medical care insurance coverages. Specifically, it highlights the role of the Society of Actuaries in intercompany data collection, employer demands for sophisticated utilization data for comparison by industry and geographic location, sources of industry-wide data, data resource potential of health claims processing by the National Electronic Information Corporation, and antitrust implications. From Record of the Society of Actuaries 1981, Volume 7, No. 4.

Description: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

Description: The session discussion is valuation and reserving issues with regards to group medical - including HMOs, and individual medical - including disability and long-term care. From Record of Society of Actuaries Vol. 16, No. 4B.

Description: Panelelists at this session of the SOA 1998 Maui II Spring Meeting discuss the current use of risk adjusters to spread risk among various helath carriers and health plans, and whether the system is effective and equitable.

Description: At this session of the 2004 Valuation Actuary Symposium, SEC medical rollforward schedules are reviewed. The background that led to these schedules, i.e. stock analysts attempting to understand earnings results, is presented. Differences in reserving practices among managed care companies are discussed.