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 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.

Description: This is a discussion about the issues surrounding retirement at age 70. What redesigns of group life, disability, and health plans is necessary as a result of raising the minimum mandatory retirement age to 70? What is the cost effect of these changes? How do you handle benefit design in states with no mandatory retirement age? How should pension and profit-sharing plans be changed to conform to the new law? From Record of the Society of Actuaries 1979, Volume 5, No. 1.

Description: This panel discussion focuses on design and cost considerations of group health insurance including pricing, credibility formulas, cost containment, trends in morbidity experience, and improving cost effectiveness to the policyholder. From Record of Society of Actuaries 1980, Vol. 6, No. 4.

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 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: Discusses: Types of medical expense insurance being offered and features, risk management, pricing, and methods of pre-funding retiree benefits.

Description: This is a discussion of the paper, Surgical and Medical Insurance by a Blue Shield Plan by Arthur Hunter and James F. Coleman. From Transactions of Society of Actuaries 1954, Vol. 6, No. 16.