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 is the table of contents for the 1972 Reports of Mortality and Morbidity Experience.

Description: This is the 1975 report of the morbidity experience of Group Weekly Indemnity insurance.

Description: This is the preface to the 1976 Report of The Committee on Group Life and Health Insurance. The report consists of the following sections: 1. Group Weekly Indemnity Insurance. 2. Group Long-Term Disability Insurance.

Description: This paper develops a parametric model for health care insurance claims using currently available software to fit parametric models to the data. Model selection is based on the Chi-squared goodness-of-fit test and a comparison of the empirical limited expected value function to parametric limited expected value functions. From Actuarial Research Clearing House 1993, VOL. 3.

Description: This chapter focuses on creating practical models that aid in the prediction of the risk of readmission to a specific hospital within 30 days of discharge for Medicare patients, to aid in the identification and stratification of at-risk patients for hospitals considering building an intervention program in a cost-effective manner. For readers who wish to develop their own predictive model, a dataset is provided on the Actexmadriver.com website, and R code is provided in the appendix to this chapter.

Description: This discussion at the San Francisco and Washington 1966 Regional Meetings covers three topics - Disability Benefits under Life or Health Insurance Policies, Changes in Individual Medical Expense Insurance in the Light of Medicare, and Optional Modes of Settlement.

Description: This article takes a comparative review on Medicare and Private Health Insurance and examines the cost of administration. From Health Watch Newsletter, May 2006, Issue No. 52.

Description: With the medical insurance market experiencing health care inflation of 10 to 13 percent and medical costs averaging above $8,000 per year per employee less for single employees and more for employees with families, employers are looking at alternative options. Politicians and regulators are as well.

Description: This paper explores the legislation of Mass 65, the intent of which was to offer health benefits to persons aged 65 and older without evidence of insurability. From TRANSACTIONS OF SOCIETY OF ACTUARIES, 1962 VOL. 14 PT. 1, NO. 40.