Description: Discussion of methods to estimate unpaid claim liability UCL for health plans. Includes traditional IBNR lag method and a lag method based on claims reported but not paid RBNP. Issue No. 45

Description: In this paper a method is described for pricing - and reserving for- return of premium benefits under disability income policies. Followed by a discussion paper

Description: The presenters will discuss predictive analytics as applied to recent group life and disability experience studies and other applications.

Description: Panel discussion of alternative approaches to the design of reserve standards, to include those topics discussed in several recent papers and committee reports.

Description: Model design is an important part of being an actuary, and the SOA highlights the importance of the actuarial control cycle of model design, evaluation and monitoring. What tools are at our disposal for these steps? When should we be concerned or excited about model performance? Can we, and should we, use machine learning tools to assist with model improvement or development?

Description: A simple short-term disability model is developed, where the loss process is comprised of two processes: new claims process and continuing claims process. This results in a surplus function with stationary dependent increments. Three dimensional transitional probabilities are needed to model the transitions of this non-Markovian process. An approximating model with stationary independent increments is found. The approximating model leads to bounds for the finite probability of ruin. Numerical comparisons are made.

Description: The birthday rule is used to determine whether the father's or the mother's insurer is liable for a child's medical bills, where the liability rests with the insurer of the parent whose birthday falls in the first half of the year. It is assumed that the odds are even that the liable insurer will be the mother's, vs. the father's. This paper demonstrates how the key determinant of whether this assumption is valid is the distribution of the difference in spouses' ages.

Description: This paper develops a formal framework to model the behavior of individual and small group health insurance policies in a competitive market. In this framework, anti-selective lapse is not assumed, but arises as a result of rational consumers seeking the best value in a competitive market where the premium rates are restricted by law. The authors obtain a model that addresses a number of fundamental questions which have not been fully answered previously, including the effect of price-induced anti-selective lapse on the mix of insureds in a block and the optimal renewal price to maximize the aggregate profit of a block.

Description: Gather with members and non-members in the China actuarial community to discuss recent topics and related issues in areas such as macroeconomic sharing, pension, investment, product strategy, and more.

Description: The introduction of new gene and cell treatments is not without scrutiny. Although these treatments are often curative, they come with a significant price tag. Health plan actuaries find themselves wondering if the intended outcome supports the cost and whether the potential medical cost savings will offset the high drug cost. The Institute for Clinical and Economic Review (ICER) reviews results from clinical trials to produce a report evaluating the cost-effectiveness of new therapies. Depending on the results, the ICER report can be used by pharmaceutical companies to justify the high cost or by the health plan to do the opposite. Go beyond the ICER report and discuss an alternative method for valuing new drugs using nonmedical revenue streams, such as disability and nutrition benefits, and return-on-investment modeling. By attending this session, you will have a better understanding of the nonmedical revenue streams, such as disability and nutrition assistance benefits, that may offset the cost of a drug and how those revenue streams can be incorporated into return-on-investment modeling.