Description: Health claims are not normally distributed. Claims Forecasting can be improved by understanding the entire distribution of plausible values of future claims, for example knowing there is an 80% chance future claims are between $340 and $375 PMPM. Confidence intervals around our estimates allow us to understand for each range around the best estimate (for example +/- 1%) what is the probability that future claims will fall in that range. Quantile Regression is a mathematical technique where you can estimate any percentile of the claims distribution you are looking for as a function of demographics, diagnosis indicators, prior cost variables, or other significant predictors. You can see which coefficients are important at different parts of the distribution. Individual and group distributions can be constructed. There are numerous applications in pricing and underwriting, stop loss, provider profiling, ACO target setting, allocation of group risk charges based on volatility, discounting strategy, and experience analysis.

Description: Working in a silo can mean a greater risk of accidental injury or death, but it can also imperil your actuarial career.

Description: This article provides an overview of behavioral economic theory as it relates to health and welfare insurance plans and provides summaries of two sample applications of the theories: enrollment in health insurance exchanges created by the Patient Protection and Affordable Care Act, and product design considerations in light of vast health illiteracy.

Description: Update on Affordable Care Act topics, including Section 1332 waivers, Association Health Plans, silver loading and cost sharing reductions.

Description: ACA risk adjustment has now been in play for years. The original intent of risk adjustment was to help stabilize the market through measuring risk levels of each issuer. However, the risk adjustment program may have introduced additional uncertainty due to annual market shifts and model changes, making risk adjustment estimation is a difficult task. This article analyzes the results over time, including impacts from market changes and model changes.

Description: This 1978 session dealt with Group ASO and Minimum Premium Plans. Topics covered: 1. Reasons for using Administrative Services Only plans. 2. Problems with ASO plans 3. Questions to address when considering ASO plans 4. Legal issues

Description: Discussion of issues from The Credibility Task Force for Health Coverage. From Health Section News, June 1998, Issue No. 35.

Description: This session discussion is about claim processing technology. Its artificial intelligence, medical expert systems, optical scanning and electronic claim submission. From Record of the Society of Actuaries Vol. 15, No. 1.

Description: A panel of actuaries and clinical consultants at this session of the SOA 2003 Vancouver Spring Meeting provides an assessment of current and future applications of predictive modeling techniques in the health arena. A practical example of risk adjustment, discussion of the clinical use of this technique, and applications in underwriting are discussed.