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: At this presentation, the panelists address the following questions: 1. How is health insurance risk measured? 2. How and why do surplus requirements differ between health insurance and life insurance? 3. How and why do surplus requirements differ among health insurers [e.g., Commercial, Blue Cross, HMO] and among health insurance products? 3. What are some of the current techniques being used by health insurers for determining target or required surplus and for managing surplus? 4. How do the rating agencies view surplus requirements for health insurers? From the Record of the Society of Actuaries Vol. 17, No. 3A.

Description: This 1991 panel discussion is about medical claims management and keeping up with changes in technology. The panelists discuss the use of artificial intelligence in claims processing, &#39;intelligent&#39; coverage cards, and code gaming problems. From the Record of the Society of Actuaries Vol. 17, No. 4B.

Description: This session discussion is about health insurance tax reserves: standard morbidity tables, impact of statutory requirements, effective issue date for choice of interest rate, deductibility of additional reserves, and the chance for one-year preliminary term on certain coverages. From Record of Society of Actuaries Vol. 18, No. 1B.

Description: This session will discuss the role of actuaries under national health insurance, role of the Canadian health actuaries under that national program and how actuaries can shape the health-care environment in the U.S.. From Record of Society of Actuaries Vol. 18, No. 4B.

Description: This session is about managed workers&#39; compensation/24-hour health care current activities, legal considerations, casualty actuary perspective, and potential role of utilization review organizations. From Record of Society of Actuaries Vol. 19, No. 1A.

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.

Description: This session dealt with Regulatory Considerations in Group Insurance. Topics included: 1. National health insurance. 2. Federal hospital cost control programs. 3. Non-discrimination legislation and regulation. 4. Multiple- employer trusts. 5. Impact of recent OASDI financing changes. 6. Changes in mandatory retirement age on group insurance.