Description: With the increase of membership in Blue Cross / Blue Shield, this paper presents the practices and experience under the plans using the United Medical Service, Inc as a model. Transactions of SOA Vol. 6, No. 14

Description: The Health Section Research Team is pleased to make available the following research study and Excel model that provide a framework for estimating the financial impact of health plan provider network risk. The research was conducted by the Denver office of Milliman, Inc. The Excel workbook allows the user to assess cost implications of aspects of network risk under various assumptions. The assumptions in the workbook can be altered by the user and be applied to test a range of scenarios.

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: 1973 SOA Annual Meeting. This paper provided summaries of several concurrent sessions from the referenced meeting including: 1. NEW DEVELOPMENTS IN GROUP LIFE AND HEALTH PROGRAMS. 2. MARKETING INDIVIDUAL ORDINARY INSURANCE. 3. ACTUARIAL LITERATURE. 4. INDIVIDUAL DISABILITY INCOME INSURANCE. 5. GROUP SURVIVOR INCOME BENEFITS. 6. GROUP LIFE AND HEALTH - EXTERNAL DEVELOPMENTS. 7. PENSION PLAN FINANCIAL REPORTING.

Description: This is a discussion about long-range plans being used as management tools in the life insurance business. Also discussed are the implications that Medicaid will have on the private health insurance business. From Transactions of Society of Actuaries 1966, Vol. 18 Pt. 2, No. 51.

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 report compares health care utilization and expenditures between individuals with Crohn’s disease who had used infliximab and those who had not. Claims data from the 1999-2003 Thomson Reuters MarketScan commercial claims and encounters databases and inpatient, outpatient, and prescription drug claims data of individuals older than 18 years of age with a diagnosis of Crohn’s were included.

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

Description: This 1993 paper examined the premium rate changes that could have resulted from the passage of The Health Insurance Reform and Cost Control Act of 1991. From Actuarial Research Clearing House 1993, VOL. 3.

Description: 1959 SOA Regional Meeting in Atlanta. This discussion covered the advantages and disadvantages of entering the pension field through Ordinary policies or Group Annuities. The panel also discussed considerations in entering the Accident and Sickness field.