Description: Diabetes mellitus type 2 is an excellent model for assessing the setup of medical coverage in the U.S. health care system. It is a chronic disease that has genetic, behavioral and other medical causes, and causes many complications over the long term. From Financing Chronic Care Monograph, M-HB05-1.

Description: This paper discussed providing consumers of medical care with transparent and comparable price and quality information to enable them to make economically optimal decisions.

Description: In order to encourage health insurance issuers to offer health insurance coverage on the Exchange and on the individual and small group markets, while ameliorating the potential impact on any particular health insurance issuer of providing coverage without pricing for pre-existing conditions or the gender of the insured, the Affordable Care Act includes three risk-sharing programs: the Transitional Reinsurance program, the Risk Corridor program and the Risk Adjustment program (collectively referred to as the “3Rs”). The financial and tax reporting of each health insurance issuer is affected by the implementation of these risk-sharing programs because each health insurance issuer is required to pay for the programs’ costs, and some issuers are or will be eligible for benefits under them.

Description: Panelists define the various provider-centered managed-health-care entities and discuss the differences among them. From the 1997 Record of Society of Actuaries, Vol. 23, No. 3.

Description: Panelists at this session of the SOA 1998 Maui II Spring Meeting discuss the impact point-of-service [POS] plans have had on both HMOs and on indemnity carriers. Different types of POS plans and the problems presented by primary care gatekeepers are discussed.

Description: Panelists at this session of the SOA 1998 Maui II Spring Meeting discuss the strategies various insurers have taken in response to the Health Insurance Portability and Accountability Act [HIPAA] requirement to use guaranteed issue for small group and certain individual health plans to qualified individuals.

Description: This panel at the SOA 1998 New York Annual Meeting discusses the history of HMOs with respect to actuarial support and looks at how actuaries can and should be involved in supporting HMOs.

Description: This session from the 1992 Valuation Actuary Symposium reviews the appointed actuary concept, the actuarial opinion and asset adequacy analysis as they apply to health insurance and expresses the views of one regulator on the subject and one actuary in terms of the actuarial standards of practice.

Description: This session from the 1984 SOA Toronto Meeting discusses an overview of the underwriting methods and techniques used with individually issued accident and health insurance including elimination periods, underwriting limits and claims costs. From Record of the Society of Actuaries Vol. 10, No. 4

Description: This is a panel discussion session on the developments in the group insurance market in the 1980s including designing benefit plans with the employee as the focus, the cost to the corporate employer, and the group insurance underwriter's outlook.