Description: A research report describing aspects of provider network performance in health care settings with particular focus on experiences with Exchanges.

Description: The SOA’s research objective is to provide guidance to state exchange officials and administrators, federal officials and administrators, and actuaries assisting states and health plans. The goal of the project is to estimate the morbidity and/or cost for newly insured individuals in the individual market (and to some degree, the small group exchange) relative to the morbidity and/or cost for the current commercially insured population. This analysis will primarily focus on the individual, non-group market. In order to plan for the impact that these currently uninsured individuals will have on the health insurance markets, it will be important to understand their costs relative to the costs for people already enrolled, for whom many health insurers have experience and data.

Description: This paper presents a surplus-ratio goal that is appropriate for group accident and health insurance and discusses growth, the sources of gains and losses, ways to improve operating gain and tracking results against expectations. A discussion of the paper follows. From Transactions of Society of Actuaries 1977, Vol. 29.