Description: This article provides an overview of critical illness insurance: history, product description, and the three primary ways to offer critical illness coverage in the United States. This article also contains an illustration of an issue age premium rate calculation, as well as product features and rating applications specific to the various types of critical illness coverage.

Description: This article examines the costs of mental health parity, presents the primary drivers of cost increases from legislation and shows evidence the initial cost projections were too high. From Health Section News, March 2005, Issue No. 49.

Description: Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates have been adjusted, and compares those results to what has been modeled with the SOA Mediciad Unwinding model.

Description: Discussion and Opinion on how randomness affects measurement of provider contracting risk-sharing agreements

Description: Comments on editor's previously published Long-Term Health Care Resource Model article with respect to long term trend and other assumptions. Issue No. 60

Description: Results of an SOA survey regarding the expectation for 2015 accruals for 3Rs and cost sharing reduction payments

Description: According to the Actuarial Standards Board’s Actuarial Standard of Practice No. 49 (ASOP 49), actuarially sound Medicaid managed care capitation rates will include a provision for underwriting gain in order to provide compensation for the risks assumed by an MCO. However, there is no generally accepted method for quantifying underwriting gain in managed Medicaid capitation rates. This article discusses a new model developed to address this void and calculate underwriting gain. The model was developed by researching existing financial literature and performing a statistical analysis of industry data to build out a framework that can be leveraged to estimate underwriting gain.

Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

Description: The CMS Risk adjustment model allows actuaries to apply our analytical skills and business knowledge to solve risk and revenue challenges within Health Plans.

Description: This article is intended to present a high-level review of a recently concluded research project (Mehmud & Yi, 2012) with the same title.