Description: Learn about key actuarial and analytic tools and methodologies used by commercial health insurance to identify and quantify drivers of healthcare cost and utilization (including wasteful and low-value ones) and risks. Use case scenarios in which these tools and methodologies apply, such as underwriting, reinsurance, medical management for population health and chronic diseases, managed care contracting, insurance market reform, provider payment reform, etc., will also be covered. Experience from the U.S., China and other parts of the world will be shared.

Description: After the bid process, desk review, rebate reallocation, an “enjoyable” audit, and open enrollment; the Medicare plan year starts. Throughout the year, organizations find it pertinent to get an accurate picture of their Part D liability as reinsurance, LICS (Low Income Cost-Sharing) subsidy, and risk corridors are accrued. Attendees will learn about the basics of Part D accruals, how future accrual amounts are estimated based on patterns in the data, and how bid assumptions versus actual results impact plan sponsor profitability. We will also discuss financial statement treatment of these items. Real-life examples from bids to outcomes will be provided to enhance the discussion. Ultimately, attendees will come away with a deeper understanding how their bid assumptions play out, and how they can use Part D accruals to plan for future bid development.

Description: More and more providers are desiring risk-based contracts instead of traditional FFS-based contracts. This session is intended to outline some of the actuarial best practices in risk-based contracting related to the many flavors of the CMS ACO programs, as well as Commercial risk-based contracts.

Description: This 1992 discussion is about the resource-based relative value scale [RBRVS]- where it is and where it's going, and its impact on trends, Medicare supplemental coverage, indemnity plans, and health cost projections. From the Record of the Society of Actuaries Vol. 18, No. 1A.

Description: This session discussion is about medical technology: trends and proliferation of medical technology, its impact, future, employer strategies to limit exposure, considerations of containing utilization of various procedures and technology. From Record of Society of Actuaries Vol. 18, No. 1A.

Description: Discussion of current developments affecting flexible-benefit plans, pricing and underwriting considerations in a flexible-benefits environment, managed care options in a flexible plan, employer challenges in managing flexible programs, employer cost target and pitfalls.

Description: 1993 SOA Spring Meeting, San Diego. This session discussed credibility theory. Areas addressed included defining credibility and the complexities of measuring it with an emphasis on group medical insurance.

Description: This discussion at a SOA 1967 Regional Meeting covers individual life and health insurance topics including individual health loss of time coverages, life underwriting, reinsurance, individual annuity retirement plans in Canada, market testing new products.

Description: This is discussion about the impact of mass marketing has on smaller companies. From Transactions of Society of Actuaries 1969, Vol. 21 Pt. 2, No 59

Description: This discussion about group Life and group Accident and Health insurance covered over insurance, medical catastrophe coverage, conversion privilege, and the regulatory environment. From TRANSACTIONS OF SOCIETY OF ACTUARIES, 1953 VOL. 5 NO. 11.