Description: This session discussion is about experience-rating and credibility in group health insurance. From Record of Society of Actuaries Vol. 18, No. 1B.

Description: This session presents a summary of actuarial and potential uses of stochastic modeling for health actuaries. Three case studies are presented: rating health plan reimbursement provisions, developing claim liabilities, and defining appropriate reinsurance levels. From the Record of the Society of Actuaries, Volume 30, No. 1, Session 18

Description: A mathematical framework for benefits and choices must be created to model 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. Finally, utility functions can be applied to this framework to predict choice.

Description: At this presentation, the panelists address the following questions: 1. How is health insurance risk measured? 2. How and why do surplus requirements differ between health insurance and life insurance? 3. How and why do surplus requirements differ among health insurers [e.g., Commercial, Blue Cross, HMO] and among health insurance products? 3. What are some of the current techniques being used by health insurers for determining target or required surplus and for managing surplus? 4. How do the rating agencies view surplus requirements for health insurers? From the Record of the Society of Actuaries Vol. 17, No. 3A.

Description: This paper describes a modified development method for analyzing claims experience and calculating claim reserves and liabilities on short-term health insurance benefits. It identifies many of the influences on claim development and discusses various ways to recognize them. From Transactions of Society of Actuaries 1989, Vol. 41.

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: 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: This paper outlines the limitations inherent in current actuarial pricing techniques and describes a macro pricing process for product development that can produce optimal decisions in competitive environments. A discussion of the paper follows. From Transactions of Society of Actuaries 1991, Vol. 43.

Description: This paper focuses on credibility when used in the underwriting and pricing of group medical insurance. In this report, group medical refers to broad comprehensive major medical coverage that reimburses the insured for practically all necessary health-related services, subject only to a very high payment limit and modest member cost-sharing in the form of copays, deductibles, and coinsurance. Readers are expected to have some familiarity with this coverage.

Description: Presented at June 2002 Spring Meeting. This session discusses how credibility varies by size of groups for various health coverages, when a block of business can be considered fully credible, how credibility can factor into a rate filling, and to what extent current experience can be considered more credible than past experience.