Description: This paper examines the details of group major-medical expense insurance, a disability coverage, also labeled as catastrophe coverage. From Transactions of Society of Actuaries 1951, Vol. 3, No. 7.

Description: This paper presents a procedure for calculating aggregate stop-loss premiums that takes parameter uncertainty into account. From Actuarial Research Clearing House ARCH 1988, Vol. 3

Description: A mathematical framework for benefits and choices must be created, in order to model flexible benefit selection. This paper creates such a framework by defining benefit plans as reimbursement functions. These are then used with a defined choice function to calculate the cost deviation due to selection. From Actuarial Research Clearing House 1992, VOL. 1.

Description: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

Description: Panelists at this session of the SOA 2001 Annual Meeting discuss pricing issues and business risks associated with life, annuity, medical expense and disability income insurance products and compare them to long-term care [LTC].

Description: This is the 1954 report in a series of annual studies of the morbidity experience of Group Weekly Indemnity insurance and Group Employee and Dependent Hospital and Surgical Expense insurance.

Description: In this paper, a model is proposed as a potential explanation for the steady deterioration in loss ratios often observed on blocks of individual health insurance policies. This model, which incorporates assumptions of anti-selective lapses, can be used for morbidity projections and projections of the effects of rate increases. Discussions of this paper are included.

Description: This paper develops a parametric model for health care insurance claims using currently available software to fit parametric models to the data. Model selection is based on the Chi-squared goodness-of-fit test and a comparison of the empirical limited expected value function to parametric limited expected value functions. From Actuarial Research Clearing House 1993, VOL. 3.

Description: The birthday rule is used to determine whether the father's or the mother's insurer is liable for a child's medical bills, where the liability rests with the insurer of the parent whose birthday falls in the first half of the year. It is assumed that the odds are even that the liable insurer will be the mother's, vs. the father's. This paper demonstrates how the key determinant of whether this assumption is valid is the distribution of the difference in spouses' ages.

Description: This paper presents a method involving re-sampling 'with replacement but without random numbers', numerical convolutions for sums and quotients, and estimation of confidence intervals for trend in average size claim. In this paper, this method is applied to major medical claims.