Description: This article chroncles the law suit that Blue Cross of Minnesota filed against all of the large tobacco companies for fraud and the extra cost incurred by all Blue Cross members. The case was settled for $469 million.

Description: MACRA not only impact providers, it will impact the entire healthcare market. MACRA published studies and commentary to date have primarily focused on providers, with the majority of the information addressing the impacts to clinicians. However, our investigation indicates MACRA has far reaching impacts to payers as well as providers. MACRA is impacting each geographic market and line of business in a unique way, and health payers will have multiple strategic decisions to consider given the changing market dynamics.

Description: In preparing claims reserves in the annual statement, health insurers and their opining actuaries will generally include a provision for adverse deviation (PAD) in their reserved amount in order to satisfy language in both in the National Association of Insurance Commissioners (NAIC) Health Annual Statement Instructions and in Actuarial Standards of Practice. This article explores the total level of PAD (both implicit and explicit margin combined) included in the reported claims reserves by examining NAIC filing data from 2016 through 2022.

Description: What can the United States learn from other countries' health care systems? How are other countries more efficient? We selected five countries that have been among those debated as having some of the most efficient health care systems to explore what the United States can learn from these examples.

Description: Presents a step-by-step methodology for calculating confidence intervals for IBNR estimates derived using the Averaqe PMPM method. It is a companion article to the January 2023 Health Watch article presenting the Average PMPM method for generating point estimates of IBNR with zero claims runout.

Description: This article gives an overview of the worksite marketing/volutary products market and addresses the pros and cons of this marketing approach.

Description: Unpaid Loss Reserve fair and reasonable test and two legal cases Utah Medical and Minnesota Lawyers Issue No. 39.

Description: This article attempts to make a modest contribution to the dialogue on the potential and risks associated with novel treatments such as cell & gene therapies. With a fast-expanding roster of what are believed to be one-time treatments at ever increasing price points aimed at curing a wider swatch of the population, they are as much a source of relief for patients stuck in medical limbo, as they are a source of anxiety for payers.

Description: This section contains book reviews on profit sharing, life insurance, genetic risks and a select current bibliography. From Transactions of Society of Actuaries 1974, Vol. 26, Pt. 1, No. 75 AB.

Description: This article describes the increasing problems in the product filing and forms approval process under state regulation. It also describes the conclusions and product filing uniformity vision that includes the formation of CARFRA which stands for Coordinated Advertising, Rate and Form Review Authority.