Description: In the time since the original proposal to move healthwriting companies from the blue blank to the orange blank, there have been several incremental updates to the blue blank by the NAIC Blanks Working Group to integrate portions of the orange blank into the blue blank. Meanwhile, the NAIC RBC Working Group has issued their proposal to change the health test for comment and appear to be moving forward with the proposal to revise the health test. This would obligate companies that write predominantly health business onto the orange blank rather than the blue blank, which they have historically used for reporting. Discover background of the revised health test, the incremental updates to the blue blank that have been implemented recently, additional incremental updates proposed for upcoming blue blanks, and the current status of the Health RBC Working Group proposal to revise the health test. Hear observations about companies that have opted to 'take the plunge' and move to the orange blank ahead of the revised health test as well as companies that have opted to remain on the blue blank and incrementally update as new requirements are integrated into the Blue blank. By attending the session, you will be able to: • Understand the context of the initiative to revise the NAIC health test. • Summarize the recent changes to the blue blank implemented by the Blanks Working Group that integrate portions of the orange blank into the blue blank. • Summarize the upcoming proposed changes to the blue blank by the Blanks Working Group that integrate additional portions of the orange blank into the blue blank. • Summarize the current status of the Health RBC Working Group proposal to revise the health test. • Provide industry perspective on companies that have opted to move to the orange blank ahead of the revised health test and companies that have opted to remain on the blue blank until the NAIC requires it.

Description: Many drugs, like the immunologic drugs used to treat inflammatory and oncologic conditions, are FDA-authorized to treat more than one condition. Given different conditions have varying clinical outcomes and costs, it is likely the same drug provides a range of value across multiple conditions. However, such drugs have traditionally had a single list price and corresponding payer net cost. Indication-based pricing and benefit design (IBPBD) is intended to address the variable clinical and economic value for the same drug across multiple treatment indications. As this trend continues to evolve, the determination of drug value by treatment indication will create risks and/or opportunities in pharmacy benefit design, ultimately impacting pharmacy PMPM forecasting and incurred costs. Learn from faculty as they: Provide the business context for IBPBD. Describe varying structural approaches. Discuss the market conditions that can motivate or demotivate payers. Explore operational barriers. Recommend a role for actuaries. To bring the discussion to life, a case study will be reviewed. By attending the session, you will be able to: • Describe the meaning of Indication-Based Drug Pricing and Benefit Design (IDPBD). • Understand the risks and opportunities with IBPBD. • Articulate the advantages and disadvantages of distinguishing the value of a drug by treatment indications.

Description: Find out more about the inforce product rate management process for health and LTC products. Requirements can vary by state, by issue era, and by product type and in some cases require filings to certify compliance on a regular basis. Discover recent trends in inforce rate management in the industry, including any changes seen coinciding with COVID-19 and its impacts to the regulators. By attending this session, you will be able to: • Describe or perform an inforce rate management for health products. • Understand the applicable state regulations. • Be informed of current industry trends for this work.

Description: Market researchers use cluster analysis to segment groups for targeted messaging. Law enforcement uses cluster analysis to identify high need neighborhoods to allocate resources effectively. Educators use cluster analysis to adapt their teaching methods to a particular group of students. More and more, health actuaries are using cluster analysis in their day-to-day work. Understand the basics of cluster analysis and potential applications through this session. By attending this session, you will be able to: • Describe the basic types of cluster analysis. • Explain health applications of cluster analysis. • Identify sources of additional information.

Description: Medicare and Medicaid finance more than half of American health care. Medicare and Medicaid are at the forefront of nearly every major change in U.S. health care payments, from DRGs in the 1980s to today’s value-based care. Listen to a conversation with Bruce Pyenson, FSA, MAAA, who recently completed six years as a Medicare Payment Advisory Commission (MedPAC) commissioner and Stacey Lampkin, FSA, MAAA, who recently completed six years as a Medicaid and CHIP Payment and Access Commission (MACPAC) commissioner. Hear about programs’ current challenges, what changes the ex-Commissioners anticipate over the next few years, and how these changes might impact Medicare and Medicaid managed care plans, and spillover into employer-sponsored and individual commercial insurance. By attending this session, you will be able to appreciate the role of Medicare and Medicaid as health care payment change agents and foresee future health care payment changes.

Description: This research project offers guidance and a model for actuaries to use when performing their professional services related to Medicaid (Title XIX) and Children’s Health Insurance Program (CHIP or Title XXI) managed care capitation rate setting, including, but not limited to, their certification on behalf of a state in accordance with the requirements for actuarial soundness as set forth in law, federal regulation, and CMS guidance, as well as the actuary’s professional obligations under the Actuarial Standard of Practice (ASOP) 49 issued by the Actuarial Standards Board.

Description: High performance providers and in turn networks are often a prerequisite for a highly competitive product. If performance is lacking, the ability to offer a competitive product on the street can be significantly hampered. Learn from a case study how an actuary might measure performance and compare and/or rank network providers on multiple concrete factors. Discussed comparators will include efficiency, care management effectiveness, market attractiveness (enrollment changes), inclusion in other health plan networks, etc. By attending this session, you will be able to use principles discussed in this session to more effectively evaluate provider networks for their employer.

Description: In this Society of Actuaries (SOA) Research Institute report, authored by consultants from Milliman, Inc. (Milliman) we aim to study the effects of hurricanes on human health: whether there is a relationship between hurricanes and the observed prevalence of healthcare utilization or certain health conditions among the affected population, whether this relationship can be observed through a healthcare utilization dataset, and whether there is an interaction between this observation and metrics of socioeconomic vulnerability.

Description: Critical illness insurance is a popular supplemental health insurance product in the U.S. market. This article discusses how carriers have recently sought to add value by expanded the benefits offered in their critical illness products. Specifically, the article discusses the consumer need and development considerations of adding benefits for autism Spectrum Disorder, Mental health disorders, Specified Disease Coverage, and enhance Cancer Coverage to a critical illness contract.

Description: The COVID-19 pandemic will have a lasting impression on all forms of life, annuity, and A&H insurance. Individual and group disability insurance are no exception. Examine how U.S. group and individual disability insurers have been impacted by the pandemic and how they are preparing for an uncertain future. Oliver Wyman will team up with experts from the insurance industry to discuss insights on the impact of COVID-19 on disability insurance, including results from Oliver Wyman’s 2022 industry survey. Learn about the past, current, and future expected impacts of COVID-19 on: - Claim experience (including mortality, incidence, recovery and SSDI offsets) - Reserving - Scenario testing - Insurer operations (e.g., claims adjudication, recertification) - Sales and persistency By attending this session, you will be able to: - Understand how disability insurers have been impacted by the pandemic across multiple facets. - Identify where and how U.S. disability insurance carriers are adapting to the new and evolving environment. - Discover how carriers see disability insurance evolving as the COVID-19 pandemic continues.