Description: Presented at June 1996 Spring Meeting. This discussion looks at how a managed care plan can know whether it is doing a good job on utilization review, if there is room for further reduction in utilization, and how a plan should prevent under-utilization.

Description: This session presents a summary of actuarial and potential uses of stochastic modeling for health actuaries. Three case studies are presented: rating health plan reimbursement provisions, developing claim liabilities, and defining appropriate reinsurance levels. From the Record of the Society of Actuaries, Volume 30, No. 1, Session 18

Description: Presented at April 1986 Spring Meeting. This session discusses how employers are trying to limit their risks under medical care plans and the implications of such strategies for carriers. This session considered the differences in the economic and random fluctuation risks, and the effectiveness of programs in controlling each.

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: The editorial shares observations and lessons learned from the process of implementing the Affordable Care Act.

Description: The American Academy of Actuaries task force charged with developing a risk-base capital formula for health insurers submitted its preliminary report to the NAIC Health Organizations Risk-Based Capital Working Group.

Description: Presented at April 1985 Spring Meeting. This session discussed: Definition of good and sufficient provision for unpaid and actuarial liabilities as used in the NAIC model bill, Actuary and auditor relationships in documentation, reasonableness of results, materiality, margins, and disclosure, Techniques for estimating unpaid claim liabilities, Reverse testing, Considerations regarding incurred date coding in establishing claim reserves, Reserving methodologies for alternative funding products, Reserves for catastrophic claims, Measurement, evaluation, and adjustment for claim department backlogs, changes in claim submission patterns, and environmental changes, etc.

Description: Summary of common mistakes made by actuaries developing ACA rate filings. Outlines correct approach to ACA rate filing process. Suggests Peer Review process.

Description: Presented at October 2001 Annual Meeting. Topics covered in this session include Internet-based health plan exchanges, defined-contribution health plans, self-directed health plans, personal spending accounts, and episodic based reimbursement to insureds.

Description: This discussion looks at recent claim experience in group accident and health, experience rating criteria, the advantages and disadvantages of providing medical coverage with a schedule of benefits, and the extent to which total and permanent disability income clauses are being offered in new group life policies.