Description: A research report describing aspects of provider network performance in health care settings with particular focus on experiences with Exchanges.

Description: The principal objective of this paper is to remind actuaries of the rather significant misconceptions and distortions commonly encountered in the use of individual accident and health insurance loss ratios. From Transactions of Society of Actuaries 1979, Vol. 31.

Description: In practice, the actuary may be required to forgo independent mathematical judgment in order to follow regulations which prescribe specific exposure or enforce counts for full and partial credibility. In this paper the authors give specific examples of such regulation from various states, and discuss the positive and negative features of the regulatory approaches. From Actuarial Research Clearing House, 2003 Vol. 3.

Description: This 1993 paper examined the premium rate changes that could have resulted from the passage of The Health Insurance Reform and Cost Control Act of 1991. From Actuarial Research Clearing House 1993, VOL. 3.

Description: The Health Section Research Team is pleased to make available the following research study and Excel model that provide a framework for estimating the financial impact of health plan provider network risk. The research was conducted by the Denver office of Milliman, Inc. The Excel workbook allows the user to assess cost implications of aspects of network risk under various assumptions. The assumptions in the workbook can be altered by the user and be applied to test a range of scenarios.

Description: This paper presents population hospital utilization data concerning the proportion of total hospital days that is due to injury and the proportion of total hospital days that is spent in intensive care units for use in obtaining reserve factors. The paper also presents continuation data for hospitalizations. From Transactions of Society of Actuaries 1979, Vol. 31.

Description: Since detailed claim information is not readily available to the Committee on Group Mortality and Morbidity on an annual basis, a special investigation of group hospital expense experience has been conducted. That investigation is summarized in this paper, and covers plan descriptions, morbidity and cost data, and continuation tables.

Description: 1973 SOA Annual Meeting. This paper provided summaries of several concurrent sessions from the referenced meeting including: 1. NEW DEVELOPMENTS IN GROUP LIFE AND HEALTH PROGRAMS. 2. MARKETING INDIVIDUAL ORDINARY INSURANCE. 3. ACTUARIAL LITERATURE. 4. INDIVIDUAL DISABILITY INCOME INSURANCE. 5. GROUP SURVIVOR INCOME BENEFITS. 6. GROUP LIFE AND HEALTH - EXTERNAL DEVELOPMENTS. 7. PENSION PLAN FINANCIAL REPORTING.

Description: This study produces annual claim costs for Group Weekly Indemnity Insurance and Group Employee & Dependents Hospital & Surgical Expense Insurance and exhibits the trend in these claims costs. This report is based on a study by the Committee on Group Accident and Sickness Experience designed to satisfy that need to update previous studies due to the shift in emphasis by plan of benefit, the increase in level of hospital expenses and the change in pattern of these expenses. From Transactions of Society of Actuaries 1960, Vol. 12, No. 34.

Description: This paper describes a process for developing rates for a preferred provider organization [PPO]. From Transactions of Society of Actuaries 1985, Vol. 37.