Description: The SOA’s research objective is to provide guidance to state exchange officials and administrators, federal officials and administrators, and actuaries assisting states and health plans. The goal of the project is to estimate the morbidity and/or cost for newly insured individuals in the individual market (and to some degree, the small group exchange) relative to the morbidity and/or cost for the current commercially insured population. This analysis will primarily focus on the individual, non-group market. In order to plan for the impact that these currently uninsured individuals will have on the health insurance markets, it will be important to understand their costs relative to the costs for people already enrolled, for whom many health insurers have experience and data.

Description: This paper describes the construction of the 1965 Supplementary Major Medical Tabular used to measure expect4ed claims. The paper also comments on the relationship of the intercompany 1963-65 experience to it. From Transactions of Society of Actuaries 1968, Vol. 20, Pt. 1, No. 56 AB.

Description: This paper investigates the accuracy of loss reserves by comparing some reserves with the actual results five years hence. The ultimate purpose was to provide an estimate of the amount of variability which cannot be explained by listed factors. The resulting amount of variability gives an indication of the amount required for a provision for adverse deviation. From Actuarial Research Clearing House 1991, VOL. 1

Description: This paper suggests that many problems in health insurance pricing can be solved by requiring a minimum mandatory paid-up period [i.e., premium period shorter than insurance period], and by encouraging insureds to persist by providing them adequate pricing information. This will generate significant investment income for insuring programs and reduce the cost of insurance.

Description: The birthday rule is used to determine whether the father's or the mother's insurer is liable for a child's medical bills, where the liability rests with the insurer of the parent whose birthday falls in the first half of the year. It is assumed that the odds are even that the liable insurer will be the mother's, vs. the father's. This paper demonstrates how the key determinant of whether this assumption is valid is the distribution of the difference in spouses' ages.

Description: This paper discusses the purpose and nature of the benefit ratio [otherwise known as active life] reserve in relation to the class of health insurance contracts to which it is intended to apply. From Transactions of Society of Actuaries 1988, Vol. 40, Pt. 1.

Description: A research report that first defines ERM and provides the results of an applicable literature search with hyperlinks and then describes the current state of Enterprise Risk Management practices for health organizations. Areas covered: 1. Operational Risks. 2. Balance sheet risks. 3. Pricing discipline. 4. Asset risks. 5. Learnings. 6. Emerging risks.

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

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 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.