Description: This article begins with a comparison of the commercial risk adjuster to the exisiting Medicare model, and goes on to discuss why the existing strategies employed by health plans will not work in a risk adjusted environment. The article elaborates on the importance of diagnosis coding, controlling member mix, and care management in order to mitigate risks and gain from newly created opportunities.

Description: Article provides a market scan of recent state proposals for Medicaid work requirements as well as measures the impact to enrollment in different states.

Description: Article suggests future steps with regard to this project and provides information on where to get the essays.

Description: Restoration of Benefits ROB: the provision of a long-term care policy that allows policyholders to restore their maximum benefit period after they have used some or nearly all of their policy benefits to pay for a covered claim event. This is a provision that should be managed closely.

Description: Sponsors of DB plans are being forced to focus on their plans as never before. A confluence of events—market downturn, aging workforce and changing legislation/regulation—has meant the status quo no longer applies to companies’ DB plans.

Description: This article addresses issues of importance to HMO excess reinsurance purchasers when negotiating a reinsurance treaty.

Description: An insurance company selling LTCI today would do far better to address some important financial needs by taking the aspirin of improving modeling and pricing, and not the morphine of shutting down the business line entirely. The aspirin can consist of two strategies: First, integrate the projections of the asset portfolio and the claims liabilities when testing the sensitivity of assumptions or stochastically modeling the product. Second, establish a separate asset portfolio for LTCI products, and make sure it has a strong, well-defined, well-documented Investment Policy Statement. An Investment Policy Statement will enable pricing actuaries and investment departments to work together with the same goals and objectives.

Description: View the complete issue for the August 2014 Reinsurance News newsletter.

Description: A discussion of the value a reinsurer can provide beyond assistance through coinsurance with XXX compliance. There are recent signs that the use of coinsurance and the inherent shift of the burden of the reserves to the reinsurers are putting stress on the reinsurers’ capacity limitations. Reinsurers are able to shoulder only so much of the burden of the reserve strain caused by Regulation XXX. What reinsurers do best, and know best, though, is mortality risk. If your company is seeing signs from your reinsurers that this is the case, this article will present some thoughts to consider as to why sales of level term products may still be acceptable, even without the support of coinsurance programs.

Description: Read the August 2018 issue of Risk Management published by the Joint Risk Management Section. Newsletters provide practical information for the working actuary, articles on trends that impact sections and news about section activities.