Description: This report provides morbidity experience under Individual Loss-of-Time policies, 1974-1975.

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 article provides a summary of selected sessions of the October 2010 NAIC meeting.

Description: Summary of the National Conference on Medical Costs, held in Washington, D.C. on June 28-29, 1967.

Description: Presented at May 1985 Spring Meeting. Discusses current financial reporting topics related to both group and individual health insurance, including: Standards of practice for health actuaries, Deficit Reduction Act of 1984 DEFRA, Qualifications for health certification, Internal management reporting needs, New state reporting requirements.

Description: Presented at October 1985 Annual Meeting. This session is about actuarial implications of individual choice, antiselection problems for medical coverages, plan design considerations, flexible benefits program experience, impact of alternative delivery systems on insured plan.

Description: This session discussion legal liability for unfavorable medical outcomes, effect of utilization review on the quality of care and patient/provider acceptance, protocol development and implementation for managed care, and insurance coverage necessary to protect your organization. From Record of the Society of Actuaries 1987 Vol. 13, No. 1.

Description: This session from the 1994 Valuation Actuary Symposium focuses on long-term projections of health insurance, the uses of the projections, the type of model to use and model considerations for the projections.