Description: Health Care in Ireland public care, private insurance, risk adjustment Issue No. 39.

Description: September’s Actuary contained an excellent summary by Drew Davidoff of renewal rating for small group medical business. Among the techniques he describes are age, sex, and area rating, experience rating using credibility, experience rating using tiers, examination of the diagnoses in the claim file, and initial and reentry medical underwriting.

Description: Health Watch, Issue 79, December 2015, Health Watch

Description: Under the Affordable Care Act (ACA), groups with 50 or less full time employee equivalents will eventually be subject to the ACA’s modified community rating rules. While some groups will see lower premiums than they would have without the ACA, others will see significant premium increases. Many of the latter type opted for transitional relief beginning in 2014 to avoid the ACA as long as possible. With the end of transitional relief approaching in 2018, what will these groups do? One option will be to self-insure using a product generically termed Level Funding.

Description: This paper derives exact expressions for the ultimate ruin probability and establishes the effect of correlation on ruin probability using the Wiener-Hopf factorization.

Description: In this article, the author, reflecting upon his own experiences, discusses why meaningful individual health insurance, unlike other lines of individual coverage, is generally not offered by insurers to individuals with long-term needs.

Description: This paper describes a new major medical policy from The Equitable. The author describes the policy and discusses anticipated claims experience and the calculation of gross premiums. From Transactions of Society of Actuaries 1955 Volume 7, Number 17.

Description: Discusses variability in per capita health-care costs by health-care provider.

Description: During the past few years, performance, cost, and risk trends for Medigap products have undergone substantial changes. Some of these trends could ease cost pressures on Medigap insurers, while others might increase them. Part 1 of this Issue Brief article discusses current changing trends and considerations around about how they are impacting Medigap.

Description: Discussion of how to mature value-based contracts between health insurers and provider organizations to improve population health and financial sustainability. Centers around contract parameter consistency, revenue predictability and risk assessment. Intended audience are health plan and ACO actuaries and leaders. Authors are writing from the provider perspective in value-based contracts.