Description: This article examines the concept of Actuarial Value, especially as it applies to the Medicare plan of benefits. It discusses the cost-sharing responsibility of Medicare beneficiaries and the means by which they mitigate this risk.

Description: A new statistical approach is presented for calculation of Incurred But Not yet Paid, IBNP, claim amounts. It is based on two new variant methods, the Simple Projected Paid Lag method and the Regressed Projected Paid Lag method.

Description: Discussion of insolvency provision added to reinsurance agreements to insure the continuation of benefits during HMO insolvency, Issue No. 39.

Description: Article discusses what happends when an insurer fails, role of the guaranty association and what is an ideal insolvency. From Health Section News, August 2000, Issue No. 38.

Description: This article is a submission to a Leadership Inspiration contest.

Description: Social Insurance & Public Finance Section council members provide a recap of sessions from the 2021 SOA Health Meeting, with a focus on sessions covering Medicare, Medicaid, the ACA, and public policy. The authors include a description of SIPF Section-sponsored sections, including a session on the ACA and a session on CMS's Direct Contracting Model.

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: This is Part 2 of 2 on changes affecting Medigap insurers. It focuses on marketing and regulatory differences between Medigap and Medicare Advantage that affect the competitiveness of Medigap plans.

Description: Examines the question of whether health-care costs, or health insurance costs, are in crisis.

Description: This article discusses Medical Savings Accounts MSA as proposed in federal legislation and the problems that actuaries will face in predicting their use.