Description: A closer look at family tier factor rating assumptions, and how well they reflect actual claim cost data.

Description: This actuarial memorandum represents the first, formal actuarial opinion regarding the reasonableness of the premium estimates the Clinton Administration presented with its proposed Health Security Act. The memorandum presents the assumptions and methods used to develop an average 1994 premium estimate for the standard benefit package.

Description: A discussion of the efforts to implement straight through processing and standardization of the HIPAA form for long term care claims data.

Description: Insurers are becoming increasingly involved in the development and marketing of prepaid health care service plans, or Health Maintenance Organizations HMOs. The article describes four different approaches for establishing capitation rates for HMOs 1. Integrated Budgeting Approach, 2. Inventory Approach, 3. Group Insurance Rating, and 4. Actuarial Approach.

Description: Summary of common mistakes made by actuaries developing ACA rate filings. Outlines correct approach to ACA rate filing process. Suggests Peer Review process.

Description: The medical scheme approach adopted by several African countries has failed to meet the needs of those in informal employment and rural communities. This is partly due to affordability amongst these individuals as well as a lack of awareness of how healthcare financing products work. Community based healthcare organisations have achieved greater levels of success in this regard by carefully incorporating the peculiarities of communities in benefit design and involving community members in the management of these healthcare solutions. There are lessons to be garnered from the countries where these have been implemented with some level of success. Even as countries aim towards universal health coverage, observing the unique needs of different communities within a country is essential to ensure resources are utilised efficiently and that healthcare needs are targeted effectively.

Description: Description and specifications for the health section's article-writing contest on the topic of provider payment reform.

Description: This issue wraps up the publication of essays to explore solutions available to address risks in retirement and focus on risks in a DC environment.

Description: Read the November 2016 issue of Health Watch published by the Health Section. Newsletters provide practical information for the working actuary, articles on trends that impact sections and news about section activities.

Description: A study of disability experience examines cost burden and degree of disability, and how these measures vary across different subpopulations. This article summarizes a presentation given at the Society of Actuaries’ Living to 100: Survival to Advanced Ages International Symposium held on Jan. 7–9, 2008 in Orlando, Florida. An abstract of the author's paper was presented in the September 2008 issue of Long-Term Care News.