Description: The article is a case study of various actuarial concepts invovled in the design and implementtion of the AQC - a global budget provider payment arrangement implemented by Blue Cross Blue Shield of MA.

Description: Panel discusses trends in large health claims, recent experience, and future expectations, as well as the impact of managed care on large individual health claims under self-insured programs and under an HMO setting. From the Record of the Society of Actuaries, Vol. 25, No. 2.

Description: This article is about the Course 8 series. Course 8 provides candidates with essential advanced specialized education in one of seven practice areas: individual insurance, group life and health, managed care, U.S. pensions, Canadian pensions, finance, and investments.

Description: Using the Health Care Cost Institute (HCCI) database, we examined which characteristics best predict and describe high-cost members.

Description: This article will consider several issues arising from ACO budgeting and pricing of stoploss coverage, including: 1) attribution of members; 2) claim carve outs; 3) ambiguous stoploss terms; 4) providers gaming the system and 5) credibility of data.

Description: A brief description of current events and techniques that may impact trend models.

Description: The moderator will review senior health products: Medicare supplement, Medicare risk, hospital indemnity policy HIP, cancer, accidental death AD, and employer continuance. Discussion will include product design, pricing, administration, regulation, and marketing. From the Record of the Society of Actuaries, Vol. 21, No. 1.

Description: In the course of consulting engagements, actuaries almost always find they need one or more of the following resources: -Healthcare data, which may be at the individual patient level or on a particular population. -Health services research studies which describe, summarize, try to alter, or predict patients’ use of health resources. -Health policy information, which describe public or private actions which affect the access, cost and quality of medical care. This document describes the ever-changing resources and specifies where they may be obtained.

Description: Using the Health Care Cost Institute (HCCI) database, we examined which characteristics best predict and describe high-cost members.

Description: Panelists discuss pricing issues regarding supplemental products, which for this purpose, are defined as cancer, specified disease, student accident, and other special risk accident and health coverages. From the Record of the Society of Actuaries, Vol. 25, No. 2.