Description: This report estimates sex-specific trends in HIPAA ADL disability between 1984 and 2004 using the National Long Term Care Survey (NLTCS); estimates age-standardized 20-year changes in ADL and cognitive impairment (CI) among the U.S. elderly using the HIPAA CI trigger; estimates the joint distribution of cognitive impairment (CI) and ADL disability among aged Medicare enrollees using the HIPAA disability triggers.

Description: This SOA report describes the components of margin for calculating capitation rates in a Medicaid context along with practical issues that MCOs may face.

Description: Relative to group medical plans, discusses: recognition given to effect on morbidity of various demographic factors, consideration given to inflation in making rate guarantees, consideration given to group size, and underwriting transfer cases.

Description: This report explores two LTC insurance product concepts. The concepts were developed as part of an effort to create innovative new LTC insurance products.

Description: As carriers have learned over the last two decades, Long-Term Care insurance (LTCi) is a risky business. The intent of this paper is to illustrate how these risks can be better understood through modeling the liabilities using a Monte Carlo simulation approach.

Description: This final report is a SOA Task Force response to a NAIC request to develop valuation recommendations for long-term care insurance. Two basic sets of tables are provided: one for institutional benefits [nursing home] and one for noninstitutional benefits [home health care]. From Transactions of Society of Actuaries 1995, Vol. 47.

Description: The objectives of this paper include an assessment of the basis of volatility of experience and financial results, considering the risks and uncertainties associated with long-term policies, especially LTCi. In so doing, it is observed that a properly determined provision for risk and uncertainty is needed in premiums and reserves. It then describes the approaches that can be taken to quantify such a provision in new and re-rated LTCi. The paper discusses possible mitigation approaches that have and should be taken, especially but not limited to the use of policy design features to enhance the alignment of interests of the LTC insurer and its policyholders. It also explores the relationship between historical and expected future risks and uncertainties specific to LTCi. It concludes by pointing out the pervasiveness of the uncertainties involved, the earlier underestimation of the uncertainties involved, although the actual degree of uncertainty may have decreased over time as relevant experience has been obtained. Effective management of LTCi demands incorporation of mitigation approaches in its product design and continuous monitoring of relevant experience.

Description: This research report provides an evaluation and synthesis of the methodologies and data samples used on characterizing health care fraud.

Description: This research report is sponsored by The Society of Actuaries and the Canadian Institute of Actuaries on the Canadian health care system. Performed by Stéphane Levert, FSA, FCIA, the study (available in French and English) estimated the future costs of the Canadian health care system, assessed the sustainability of the system over a 25-year horizon, and analyzed the implications of the changes to the Canada Health Transfer proposed on Dec. 19, 2011 by the federal government. The report summarizing the findings indicates that, without significant government intervention, the Canadian health care system in its current form is not sustainable.

Description: This web page contains a link to a research report that highlights the characteristics of combination plans that serve to reduce the risks to insurers issuing life or annuity products linked to long-term care insurance. Observations are provided to assist in the understanding of the factors that explain the profit change sensitivity results and the natural hedging against major risks that inherently is present within the linked products.