Description: This session discussion is about PPOs' types of sponsors, structures, effectiveness and regulation. Includes a discussion on PPOs in the UK. From Record of the Society of Actuaries 1987 Vol. 13, No. 1.

Description: This session discusess managing mental health cost through benefit structures, utilization review, and mandated benefits. From the Record of the SOA 1990 Vol. 16 No. 1

Description: The interview discusses the ACA exchange intiatives program, a strategic project of the SOA focusing on ACA marketplace emerging data and actuarial principles

Description: The medical scheme approach adopted by several African countries has failed to meet the needs of those in informal employment and rural communities. This is partly due to affordability amongst these individuals as well as a lack of awareness of how healthcare financing products work. Community based healthcare organisations have achieved greater levels of success in this regard by carefully incorporating the peculiarities of communities in benefit design and involving community members in the management of these healthcare solutions. There are lessons to be garnered from the countries where these have been implemented with some level of success. Even as countries aim towards universal health coverage, observing the unique needs of different communities within a country is essential to ensure resources are utilised efficiently and that healthcare needs are targeted effectively.

Description: Many insurers have one or more existing blocks of LTC insurance coverage. As products are revised, older policies are affected greatly. This session discusses possible strategies for dealing with older policies. From the Record of the Society of Actuaries, Volume 29, No. 2, Session 119.

Description: The Affordable Act's risk corridor program is a temporary feature that applies to individual and small group QHPs from 2014 through 2016. Designed to protect insurers against pricing uncertainty, the program appears straightforward but has many subtle consequences. In this article, we review the need for risk corridors, the calculation itself, and the implications that result.

Description: Presented at April 1985 Spring Meeting. This session discussed: Products - design, policy provisions, impact from changes in the health care system, Marketing - traditional and alternative distribution systems and concept of product brokerage, and Administration - cost effectiveness, group trust mechanisms, use of technology, regulatory environment.

Description: Presenters discuss the differences between patient treatment protocols and length-of-stay guidelines, and some of the issues that payers confronted as the protocols were implemented. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: The authors explain a grassroots model for health-risk pooling that is being used in India. They explain why traditional health insurance models have not worked in this context.

Description: This article defines population health and discusses what is needed to manage population health under value based contracts.