Description: Explanation of Medicare Advantage STAR rating program as it relates to payment rates for MA bids. Also describes important features of the program from an actuarial perspective, how the components of the STAR rating are calculated and implications and considerations for actuaries.

Description: Feature article discussing New York’s answer to publicly-financed health insurance needs.

Description: This article describes the increasing problems in the product filing and forms approval process under state regulation. It also describes the conclusions and product filing uniformity vision that includes the formation of CARFRA which stands for Coordinated Advertising, Rate and Form Review Authority.

Description: This is a table from an article in The Actuary Magazine entitled A Strategic Analysis of the U.S. Life Insurance Industry Part II: Products.

Description: This analysis provides an overview of the functional components of the managed care system. It discusses the market forces underlying the United States’ system for health care financing and delivery and suggests how market forces impact the health care industry. The analysis focuses on societal goals for health care delivery and on managed care’s effectiveness in enabling achievement of those goals. The analysis develops and uses an innovative model developed to summarize the complex interplay among the many stakeholders, or participants, in the health care system. The model provides a framework for analysis of the many relationships among stakeholders. The analysis also highlights current issues in managed care, particularly the barriers that impede collaboration among stakeholders.

Description: In the course of consulting engagements, actuaries almost always find they need one or more of the following resources: -Healthcare data, which may be at the individual patient level or on a particular population. -Health services research studies which describe, summarize, try to alter, or predict patients’ use of health resources. -Health policy information, which describe public or private actions which affect the access, cost and quality of medical care. This document describes the ever-changing resources and specifies where they may be obtained.

Description: Paper addresses what can be done in the event of a pandemic. Article from The Marketer, LIMRA International, Volume 13, November 1 2006

Description: Examines the trends affecting the distribution system for the industry's products, and the regulatory and tax environment in which life companies operate. Also looks briefly at the state of competition in the industry.

Description: How to effectively retain top talent is a challenge that all employers face and an area in which employee benefits have been playing an increasingly important role. Traditionally, the market has been very competitive, with generic products mainly focused on outpatient and inpatient medical reimbursement, Term Life cover and accidental benefits. For large multinationals, employee benefits are often tailor-made solutions arranged via international brokers whereas small to medium-sized enterprises (SMEs) are more likely to utilize standard packages offered by insurance companies via agents. This article explores the evolution of employee benefits in Asia.

Description: Countries developing universal health care via an insurance vehicle face a variety of challenges. Deciding which benefits to include, where to proactively manage health, and how to reimburse network providers are just a sampling of the issues governments concurrently manage. Optimal choices are data-driven responses. For example, high rates of cervical cancer or increasing narcotics prescriptions are trends that can be managed through product changes, modified network payment structures, or even employer based outreach. This kind of information is typically gleaned from established health insurance claims data. However, in emerging health insurance markets, this level of granular claims data is largely missing. It is difficult to manage medical trend when the root causes are unclear. This article explores a pilot medical underwriting project in Jordan.