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 discuss the tools available for coping with increases in rates for managed-care health insurance, such as: improved information on specific providers [relative costs, charges, and efficiency], analysis of the value of managed-care administrative fees, The Leapfrog Group, other data-quality initiatives, and plan-design changes. From the 2002 Record of Society of Actuaries, Volume 28, No. 3. Session 149OF of the Boston Annual Meeting.

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

Description: In this session at the SOA 1997 Palm Desert Spring Meeting, panelists discuss how managed care dental programs work, the actuarial issues, quality issues, and the perspective of the dentist.

Description: Essay where payers desiring to optimize health gains per dollar spent should avoid “across the board” cost sharing, and instead implement a “value based” design that removes barriers/provides incentives to encourage desired behaviors for patients and providers.

Description: This paper explores the legislation of New York 65, the intent of which was to offer health benefits to persons age 65 and over without health examination or other evidence of insurability. From TRANSACTIONS OF SOCIETY OF ACTUARIES, 1962 VOL. 14, PT. 1 NO. 40.

Description: This session from the 1984 SOA Toronto Meeting discusses an overview of the underwriting methods and techniques used with individually issued accident and health insurance including elimination periods, underwriting limits and claims costs. From Record of the Society of Actuaries Vol. 10, No. 4

Description: In order to encourage health insurance issuers to offer health insurance coverage on the Exchange and on the individual and small group markets, while ameliorating the potential impact on any particular health insurance issuer of providing coverage without pricing for pre-existing conditions or the gender of the insured, the Affordable Care Act includes three risk-sharing programs: the Transitional Reinsurance program, the Risk Corridor program and the Risk Adjustment program (collectively referred to as the “3Rs”). The financial and tax reporting of each health insurance issuer is affected by the implementation of these risk-sharing programs because each health insurance issuer is required to pay for the programs’ costs, and some issuers are or will be eligible for benefits under them.

Description: This article summarizes major insurance related litigation in 1951 on subjects related to assignment of risks, war clauses, effective date of surrender, premium due dates, misrepresentation, aviation exclusion, premium taxes, insurable interest, and group versus individual insurance.

Description: In this session we will discuss the impact of regulation changes that will allow members with End State Renal Disease (ESRD) to sign up for Medicare Advantage in 2021 for the first time. We will delve into the current basics of how ESRD works, the characteristics of the population that is currently on original medicare today, and a comprehensive look at what plan sponsors should be thinking about going into 2021.