Description: Watch as presenters highlight the SOA's work on an updated Medicaid underwriting margin model. This research project includes the model along with a set of instructions and a paper describing the key components of underwriting margin, including cost of capital and risk margin. The model was created as a tool for Medicaid actuaries representing both MCO and state principals to determine appropriate underwriting margin components within Medicaid managed care rates. In addition, explore a brief description of the motivation for an underlying theory behind the model. Walk through different model inputs and run through some realistic scenarios that Medicaid actuaries may encounter in states where they operate.

Description: This Fellowship credit research paper describes the use of fuzzy sets applications to the selection of group health risks. In general, fuzzy set theory is implemented to describe collections of objects whose boundaries are not precisely defined, as in the judgment of what constitutes a good risk group. First, single-plan underwriting is considered, then the work is extended to multiple-option plans.

Description: 1973 SOA Regional Meetings, Saint Paul and San Francisco. This paper provided a summary of several concurrent sessions from the referenced meetings including: 1. PRICE DISCLOSURE AND COST COMPARISON. 2. INDIVIDUAL LIFE AND HEALTH UNDERWRITING. 3. TIME SERIES ANALYSIS AND FORECASTING. 4. INDIVIDUAL HEALTH INSURANCE - PROBLEMS AND PRODUCT TRENDS. 3. VARIABLE LIFE INSURANCE. 6. POLLUTION, POPULATION, AND THE QUALITY OF LIFE. 7. HEALTH MAINTENANCE ORGANIZATIONS.

Description: "A crucial importance in forecasting is to be able to distinguish cases when temporary slowdowns in health care utilization are followed by a “rebound” period of higher utilization. Come explore an analysis of a new mathematical model describing the return-of-care process. By means of simulation and case studies using the R programming language, the relationship between the visibility of these effects and the endogenous variance of the utilization time series is explored. After attending this session, you will be able to: Describe the parameters and mathematical form of the model Apply the model to real-world utilization data"

Description: Tree models have been found to provide a good fit to group long term disability recovery and mortality rates. This research paper provides an overview of tree models, and details how they have been used for developing these rates.

Description: This session from the 1983 SOA Hollywood, Florida Meeting discusses the practical application of risk analysis technique In Health Insurance. This includes using company claim information and multinomial distributions for predictive purposes and using this information to price health insurance. From Record of Society of Actuaries Vol. 9, No. 4

Description: Vincent Kane recaps the “Statistics for Reading the Health Services and Policy Literature” session at the SOA ’10 Health Meeting.

Description: This paper suggests that using the entire runoff triangle to keep a tail on the runoff curve was not necessary, and that doing so was actually a disadvantage if group medical and dental claim payment patterns changed over the period being used. An alternative was presented. From Actuarial Research Clearing House 1993, VOL. 3.

Description: This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

Description: This report outlines the current wellness environment, the objectives of the wellness study and provides a summary of the overall study findings. This report is supplemented by the Research Summary Report, Survey Results, and Interviews with Researchers. This document includes a summary of key findings from each of the three phases.