Description: This discussion about group Life and group Accident and Health insurance covered over insurance, medical catastrophe coverage, conversion privilege, and the regulatory environment. From TRANSACTIONS OF SOCIETY OF ACTUARIES, 1953 VOL. 5 NO. 11.

Description: This discussion is about the actuarial considerations that should surround proposals in Congress for reinsurance of health plans. From Transactions of Society of Actuaries 1954, Vol. 6, No. 14.

Description: This discussion on major medical expense insurance examines the trends in the types of plans sold, popularity of the comprehensive type of medical expense insurance plan, special problems, and dependent coverage. From Transactions of Society of Actuaries 1959, Vol. 11, No. 29 AB.

Description: Diabetes mellitus type 2 is an excellent model for assessing the setup of medical coverage in the U.S. health care system. It is a chronic disease that has genetic, behavioral and other medical causes, and causes many complications over the long term. From Financing Chronic Care Monograph, M-HB05-1.

Description: This paper discussed providing consumers of medical care with transparent and comparable price and quality information to enable them to make economically optimal decisions.

Description: This essay highlights a view that many have for meeting these goals is one of a two-tiered system. The first tier in this system is a universal one controlled by the federal government, while the second tier is a private sector supplementing the first tier. The remainder of this paper will examine this two-tiered system and how various stakeholders in today’s system will be affected.

Description: After the bid process, desk review, rebate reallocation, an “enjoyable” audit, and open enrollment; the Medicare plan year starts. Throughout the year, organizations find it pertinent to get an accurate picture of their Part D liability as reinsurance, LICS (Low Income Cost-Sharing) subsidy, and risk corridors are accrued. Attendees will learn about the basics of Part D accruals, how future accrual amounts are estimated based on patterns in the data, and how bid assumptions versus actual results impact plan sponsor profitability. We will also discuss financial statement treatment of these items. Real-life examples from bids to outcomes will be provided to enhance the discussion. Ultimately, attendees will come away with a deeper understanding how their bid assumptions play out, and how they can use Part D accruals to plan for future bid development.

Description: More and more providers are desiring risk-based contracts instead of traditional FFS-based contracts. This session is intended to outline some of the actuarial best practices in risk-based contracting related to the many flavors of the CMS ACO programs, as well as Commercial risk-based contracts.

Description: This article discusses new opportunities for states to waive certain marketplace requirements of the Patient Protection and Affordable Care Act. The article focuses on specific opportunities for states and the role that actuaries will play.

Description: This article is an interview with an actuarial leader.