Description: In this article, the authors explore how the recession has impacted new member enrollment in the various state health care programs and the resulting impact on trend.

Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: An update on HMO market trends and reinsurance products, and services supporting them.

Description: Panel session exploring a variety of issues connected to long-term disability reserve buyouts, including: · Advantages and risks for buyers and sellers · Use of appropriate reserving assumptions · Possible financial structures for a buyout

Description: Recently, actuaries have become more involved in formulary decisions due to high and variable pharmacy cost and utilization trends. How can actuaries and pharmaceutical manufacturers work together to better predict the market while covering key drugs? What discussions are currently taking place between manufacturers and payers? Is there value in these discussions that actuaries are missing? This presentation will provide both actuarial and manufacturer perspectives in order to create a mutual understanding that will begin to direct future conversations to benefit both stakeholders.

Description: The evolving specialty pharmacy environment has created difficulties for actuaries pricing and forecasting pharmacy coverage. Unpredictable specialty pharmacy trends have increased insurers' earnings volatility and affected members' health care affordability. The presenters will highlight the current specialty drug development pipeline and explore specialty pharmacy drug trend management strategies. They will also provide concepts to help manage the coming wave of gene and cell therapies.

Description: An article that illustrates an actuary's finding that that federal and state governments spend more dollars for health care than employers and individuals spend for health insurance plans.

Description: Panel discussion of prospects for cost containment of, and alternatives to, fee-for-service health care, and management of health care under national health insurance. Discussion points include cost containment devices, HMOs, economic impact, cost escalation, self-insurance, stop-loss, claims administration, loss of state premium taxes, and Phase 3 tax problems under NH1.

Description: This actuarial memorandum represents the first, formal actuarial opinion regarding the reasonableness of the premium estimates the Clinton Administration presented with its proposed Health Security Act. The memorandum presents the assumptions and methods used to develop an average 1994 premium estimate for the standard benefit package.

Description: This session is about health underwriting cycle. Topics include recent experience, forecasting where the industry is heading, and what will a federal program do to the cycle. From Record of Society of Actuaries Vol. 19. No. 4B.