Description: This is a discussion about long-range plans being used as management tools in the life insurance business. Also discussed are the implications that Medicaid will have on the private health insurance business. From Transactions of Society of Actuaries 1966, Vol. 18 Pt. 2, No. 51.

Description: With the increase of membership in Blue Cross / Blue Shield, this paper presents the practices and experience under the plans using the United Medical Service, Inc as a model. Transactions of SOA Vol. 6, No. 14

Description: This research report provides an evaluation and synthesis of the methodologies and data samples used on characterizing health care fraud.

Description: This article will clarify valuation issues for the waiver of premium benefit in Accident and Health products.

Description: This 1993 paper examined the premium rate changes that could have resulted from the passage of The Health Insurance Reform and Cost Control Act of 1991. From Actuarial Research Clearing House 1993, VOL. 3.

Description: At the end of 1963 health insurance claim reserves and liabilities held by companies on this continent totaled well over one billion dollars. This paper seeks to study the problems involved in calculating these reserves and liabilities and to describe the methods in use. From Transactions of Society of Actuaries 1964, Vol. 16, Pt. 1, No. 44 AB.

Description: This research report provides an evaluation and synthesis of the methodologies and data samples used on characterizing health care fraud.

Description: In practice, the actuary may be required to forgo independent mathematical judgment in order to follow regulations which prescribe specific exposure or enforce counts for full and partial credibility. In this paper the authors give specific examples of such regulation from various states, and discuss the positive and negative features of the regulatory approaches. From Actuarial Research Clearing House, 2003 Vol. 3.

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: A research report that first defines ERM and provides the results of an applicable literature search with hyperlinks and then describes the current state of Enterprise Risk Management practices for health organizations. Areas covered: 1. Operational Risks. 2. Balance sheet risks. 3. Pricing discipline. 4. Asset risks. 5. Learnings. 6. Emerging risks.