Description: In Medicaid rate development, actuaries have not historically shared models that developed the margin (i.e., underwriting gain) assumption. This is unfortunate, given the margin assumption is one of the most critical components of the rate development in ensuring financial solvency of the Medicaid managed care organizations (MCOs). In this session, we will discuss the primary components of the this assumption and will share working models that help actuaries quantify these components—including the cost of capital and risk (or contingency) margin. We expect a lively discussion as we “open the black box” and discuss these actuarial assumptions in the public for the first time.

Description: This discussion reviews the appropriate roles of group insurance, individual insurance and governmental programs in providing protection against the cost of medical care for retired persons and other aged citizens. From Transactions of Society of Actuaries 1961, Vol. 13, Pt. 2.

Description: Panelists at this session of the SOA 1997 Palm Desert Spring Meeting discuss medical excess coverage which is provided to hospitals and/or physician groups to reimburse such groups for benefits in excess of a deductible. This coverage typically involves situations where providers are taking capitation.

Description: This editorial reviews the benefits of managed care, notes the public pressure to relax controls around this system and the expected cost impact of doing so.

Description: Discusses: Types of medical expense insurance being offered and features, risk management, pricing, and methods of pre-funding retiree benefits.

Description: This session is about managed workers' compensation/24-hour health care current activities, legal considerations, casualty actuary perspective, and potential role of utilization review organizations. From Record of Society of Actuaries Vol. 19, No. 1A.

Description: Panelists discuss emerging valuation-actuary-related issues, including: [1] for long-term-care insurance [LTCI], reserves, risk-based capital [RBC], and new experience forms, [2] for Medicare Part D, several potential future changes, and [3] for health insurance in general, the new Statement of Standard Accounting Practice 85 [SSAP 85] and existing SSAP 84, and current activities of the International Accounting Standards Board [IASB] regarding a definition of 'insurance.' Session 27PD of the 2005 Valuation Actuary Symposium.

Description: A humorous look at the spring 2013 activities that a health care actuary working on individual or small group health care reform would be involved in.

Description: Panel discussion on how insurers can deal with the proliferation of laws, court decisions and regulations, and on the outlook for future developments in health insurance regulatory environment.

Description: This article introduces a research report that studied the relationship of nontraditional variables with health costs.