Description: This panel discussion about loss reserves for health insurance provides an overview of the various methods of developing them, and analysis of the different reserve-development patterns for: Hospital, Surgical and Medical, Dental, Major Medical, and Comprehensive Major Medical. From the 1987 Record of Society of Actuaries, Vol. 13, No. 1.

Description: Discusses health-care-cost reimbursement structures, from the facility/hospital perspective and the professional/doctor perspective. Also discusses risk-absorption methods. From the 1987 Record of Society of Actuaries, Vol. 13, No. 1.

Description: Presented at June 1996 Spring Meeting. This discussion looks at redirecting the traditional role of the actuary into new areas such as working with doctors to deal with medical management issues, dealing and negotiating with providers and how to help the company develop a provider payment strategy. Employers negotiating directly with providers is also discussed.

Description: This presentation is a Health Section meeting from the 1991 Annual Meeting of the Society of Actuaries, held October 20-23 in Toronto. The session leader, the incoming chair of the section, covers administrative matters, and then the next speaker addresses a newly completed research project, sponsored by the Society and Health Section, on the variation by duration in small group medical insurance claim costs. The speakers then discuss current developments in small group reform, and the various parties involved, including the National Association of Insurance Commissioners [NAIC], and the Health Insurance Association of America [HIAA], and the work that has been done, including modeling to address the impact of a small group reform mechanism. The speakers discuss how the various parties' objectives can differ. Discussion from participants is included. From the Record of Society of Actuaries, Volume 17, No. 4B.

Description: This is a panel discussion session on the purpose, rationale and conclusions of the Committee for Accident and Health Valuation Principles. Discussion also covers the comments received and any modifications to their original draft report.

Description: This session from the 1992 Valuation Actuary Symposium explores claim reserves, including reserves for stop-loss products, claims reserves for group disability insurance products LTD, and claim reserves for shorter term claim payouts primarily major medical type products and Medicare supplement type products. It also covers Actuarial Standard of Practice 5 dealing with incurred health claim liabilitities.

Description: This session will teach the ABCs of HMOs and PHOs. Topics include provider networks, contracting, utilization controls, integrated health care, From Record of Society of Actuaries Vol. 20, No. 3A.

Description: The measure of a health-care provider's quality and efficiency can be used to reward or penalize the provider through reimbursement strategies and plan designs. Panelists discuss the measures that are becoming available. From the 2002 Record of Society of Actuaries, Volume 28, No. 2. Session 24PD of the San Francisco Spring Meeting.

Description: This 1981 session focused on health insurance coverages. Questions included: 1. What are problem areas that have given rise to recent legislative and regulatory activity? 2. What new or different sales practices are being utilized to alleviated consumerist and regulator concerns? 3. How have legislative restrictions on product design and sales practices affected pricing adequacy, morbidity experience and the long-range availability of such coverages? 4. What can actuaries do to educate the public and regulators about cost projections and premium adequacy? 5. Is it ethical to market a product with a low benefit payoff, high expense ratio? From Record of Society of Actuaries, Vol. 7, No. 2.

Description: Experts discuss new strategies related to provider contracting and network management. Topics include various reimbursement approaches and risk-sharing arrangements, unique risk arrangements for certain provider specialties, unique risk managements for specific diseases, and the role of care management/care coordinators. From the 2002 Record of Society of Actuaries, Volume 28, No. 2. Session 59PD of the San Francisco Spring Meeting.