Description: Tis is a discussion about many issues related to individual and family major medical insurance including deductibles and coinsurance, experience and trends, coverage for old age and substandard risks, guaranteed renewability for life, limitations for mental illness, and problems in underwriting and claims administration. From Transactions of Society of Actuaries 1959, Vol. 11, No. 31.

Description: Through a case study, this session at the 2004 Valuation Actuary Symposium explores the issues e.g., grouping, expenses, time period, etc. involved in determining deficiencies reserves for health products. Accounting guidance and standard industry procedures are discussed.

Description: This session will explore the national landscape of state Medicaid risk adjustment program design & application and the key differences that drive effective managed care organization program management. Risk adjustment is a mechanism to adjust capitation rates between Managed Care Organizations to account for population morbidity differences. Although many states utilize this mechanism, the application of risk adjustment can vary significantly across states. The primary differences include populations, risk score models and data collection. These state application nuances affect the strategies and tactics utilized by MCOs for effective risk adjustment program management including provider financial alignment, encounter data submission and the capture of accurate diagnosis codes. The session is intended for Medicaid Managed Care Actuaries working to develop or support comprehensive risk adjustment program management functions.

Description: This panel discussion was presented at the SOA's May 1976 Meeting in Houston. The topics covered included: experience rating problems, group life problems, Long Term Disability issues, Association Group, and utilization of HMOs. From Record of the Society of Actuaries 1976, Volume 2, No. 2.

Description: Discusses the significant historical facts and trends in the development of Individual Health and Accident Insurance business, the types of benefits offered by various carriers, and in what ways the purposes, problems and practices of health and accident insurance relate to those of life insurance.

Description: Discusses basic principles which should be observed in the selection of risks for individual health insurance, substandard underwriting, and how sales policies and claim administration practices are related to underwriting.

Description: The presenters will provide updates on research being conducted under SOA sponsorship. This includes projects on the topics of Direct Primary Care and Patient Centered Medical Homes.

Description: The evolving specialty pharmacy environment has created difficulties for actuaries pricing and forecasting pharmacy coverage. Unpredictable specialty pharmacy trends have increased insurers' earnings volatility and affected members' health care affordability. The presenters will highlight the current specialty drug development pipeline and explore specialty pharmacy drug trend management strategies. They will also provide concepts to help manage the coming wave of gene and cell therapies.

Description: While intended to assist health plan actuaries responsible for stress testing and ORSA filings, this session will also be informative for actuaries interested in communicating the impact of potential catastrophic events for health plans to their management and board. It will begin with a discussion of event thresholds for stress tests and their impact on capital and financial statements. Presenters will take a detailed look at several catastrophic event case studies (historical and hypothetical) in the following areas: healthcare specific (e.g. pandemic, specialty Rx), financial institution/credit market, operational/business, strategic and multi-event scenarios.</

Description: This presentation from Session 71PD of the SOA 1996 Colorado Springs Meeting discusses demutalization, mergers of health maintenance organizations [HMOs], and conversion from nonprofit to for-profit. It also addresses the question: How does an actuary value HMOs? From the Record of the Society of Actuaries, Vol. 22, No. 2.