Description: This article discusses a multiyear design for stop-loss reinsurance used by employers offering self-funded medical benefit programs.

Description: This discussion addresses the following questions about health insurance maternity benefits: 1. What has been the claim, lapse, and expense experience on hospital-medical policies with maternity benefits issued to young married couples? 2. To what extent have hospital-medical policies been introduced with reduced maternity benefits during the early policy years or with no maternity benefits? 3. What other measures are being used to provide maternity benefits on a self-sustaining basis? 4. Are these measures effective? From Transactions of Society of Actuaries 1963, Vol. 15 Pt. 2

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: "The ACA RADV Program will begin to impact issuers’ risk transfers in the 2018 benefit year (BY) – potentially significantly. The program is expected to continue into the 2019 BY and beyond. Therefore, health actuaries working in the ACA market need to understand this program and its potential impact.The session includes panel experts who will provide attendees with high-level overview of the program, discuss the findings from a national study, and RADV’s ultimate impact to risk transfers, as well as downstream impacts to financial and pricing decisions. The nationwide study is based on 300+ issuers’ 2016 RADV results and contains emerging insights into the new ACA RADV program otherwise unavailable. The panel’s agenda will include:1. A succinct overview of the ACA RADV Program will be provided2. Summary of a national 2016 ACA RADV pilot study results and its findings. 3. Preliminary results from a national 2017 RADV study will be discussed (or CMS published results if available prior to session). 4. Walkthrough of how RADV results impact the overall risk adjustment transfers in the ACA market. 5. Finally, the panel will discuss RADV impact to issuer’s financial accruals and pricing strategy. 6. General Q&A, discussion"

Description: Discusses the rapidly growing AIDS epidemic and its impact on traditional underwriting principles for life insurance and health insurance.

Description: This paper will develop an aggregate claim reserve methodology for health claims. The theoretical nature of the unpaid claim process is outlined and discussed. This is then used to develop a paradigm shift, which views the claim reserve estimation as a projection of claims from one period to another, rather than as a matter of estimating residual unpaid claims from observed paid claims.

Description: This 1977 panel discussion focused on effective product management of life insurance. Topics included: 1. Definition of effective product management 2. Internal organization required 3. Establishment of objectives for a product line 4. Coordination of company activities with respect to initial design 5. Monitoring

Description: This article describes a method that can be useful when re-fitting a risk score model to a population of only moderate size. Learn how to use concepts like ridge regression to train a model with partial credibility.

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 article is from the Digest of Informal Discussion, Transactions of Society of Actuaries 1956 Volume 8, Number 20. The article identifies the participants and summarizes each person’s comments. The participants discuss recent developments in expanding major medical expense coverage under individual policies and group policies, and progress made in providing hospital, surgical and medical expense coverage beyond age 65. Guaranteed renewability and substandard issues are discussed.