Description: Any prudent organization that is obligated to cover health claims will consider the risk that those medical claims vastly exceed expectations. This is true for an employer self-funding employee health benefits, a health system contracted with two-way risk (e.g., Accountable Care Organizations ACOs), and a small or mid-sized health insurance company. Without protection, these risk bearers can incur ruinous losses. Interestingly, the forms of insurance sold to cover such large medical claims, although quite similar, sometimes go by different names depending upon the buyer. • Employer Stop-loss (ESL): self-funded employers who want protection against large unanticipated claims • Provider Excess (PXS): at-risk health systems who have taken delegated risk from a public or private payer and desire protection against large unanticipated claims • Medical Excess/HMO Reinsurance (HMO Re): health insurers (including HMOs) who desire protection against large unanticipated claims The concepts we discuss in this article apply to all three categories of large claim risk.

Description: As today's medical and technological advances continue to be utilized and applied to diabetes mellitus (DM), a newer and even more complex framework for the disease is emerging, which may help us further our understanding of it. This article explores the most recent classification update and some of the newer thinking emerging about DM.

Description: This article presents a high-level overview of the Federal Income tax rules in section 382 regarding limitations on the use of losses after an ownership change takes place and summarizes problems and issues for the insurance industry in proposed regulations under section 382 as summarized in comments made by the industry and the ACLI

Description: The US healthcare system is among the world's most advanced, but is the highest-cost by far. At Swiss Re we studied the highest-cost US Medicare beneficiaries during 2016. The Medicare government program primarily covers seniors and individuals with disabilities. Total Medicare spending during 2016 was nearly USD 700,000,000,000. In our study, the 1% of beneficiaries with costs of USD 125,000 or higher generated 15% of total claim costs. Better understanding of these beneficiaries and their treatment could lead to improved quality and efficiency of care. Analysis of their claims can aid projections of the expected level and variance of costs. We calculated claim costs and rates, and identified higher-cost segments (including inpatient claims, individuals with disabilities or end-stage renal disease, Pacific states including California, and men). We look forward to expanding the analysis in future updates.

Description: Feature article that supports the statement that actuaries who are competent coders will differentiate both themselves and the companies they work for. Coding ability will be useful no matter what tools are utilized every day and all of those tools and communities contribute to moving actuarial processes out of the “Spreadsheet Age.”

Description: As the topic of affordable long-term care (LTC) insurance comes into focus in political conversations, we often find ourselves thinking, “What is going to happen to the private LTC insurance industry going forward?” The need for LTC in the United States is not going away, especially as the population continues to age. With this in mind, this article explores three possible future paths for LTC insurance funding and the associated implications for the private LTC industry.

Description: Feature article discussing various research programs centered on retirement needs.

Description: Read the May 2020 issue of International News published by the International Section. Newsletters provide practical information for the working actuary, articles on trends that impact sections and news about section activities.

Description: Key findings from Milliman's 2019/2020 UL/IUL survey. Provides benchmarking for UL/IUL competitors relative to trends in the industry.

Description: The article analyzes Private Letter Ruling 202031008, which considers how Internal Revenue Code sections 72(q) and (u) apply to an annuity contract issued to a trust. In particular, the Ruling interprets the terms “taxpayer,” “holder” and “held by” in those Code sections in situations where a non-qualified deferred annuity contract is issued to a grantor trust or a non-grantor trust. The Ruling’s analysis and conclusions differ in some respects depending on which of these types of trusts is involved. In addition, although the Ruling does not address sections 72(s) or 72(e)(4)(C), the Ruling has potential implications under those provisions because they also use the term “holder” and “holds,” respectively.