Description: Relative to group medical plans, discusses: recognition given to effect on morbidity of various demographic factors, consideration given to inflation in making rate guarantees, consideration given to group size, and underwriting transfer cases.

Description: This discussion covers the loss experience under superimposed plans compared with comprehensive plans, controls over increasing costs and the use of Relative Value Schedules, and deductible amounts and coinsurance provisions.

Description: Discusses how a small health insurance company may be able to create and successfully maintain its wealth through careful actuarial model considerations used in calculating reserves. A traditional and a conservative approach to calculating the reserves are compared. The conservative approach was found particularly useful when estimating reserves for an individual health insurance company with numerous product lines each relatively small in volume.

Description: Discussion of accident and sickness policies, including issues with underwriting and points for improvement. Transactions of SOA Vol. 6 No. 16

Description: This report compares health care utilization and expenditures between individuals with Crohn’s disease who had used infliximab and those who had not. Claims data from the 1999-2003 Thomson Reuters MarketScan commercial claims and encounters databases and inpatient, outpatient, and prescription drug claims data of individuals older than 18 years of age with a diagnosis of Crohn’s were included.

Description: The primary purpose of this paper is to present an alternative method of determining the profitability of the premium for a return of premium benefit through the use of a limited simulation program. Also discussed are necessary reserves for a return of premium benefit. From Transactions of Society of Actuaries 1973, Vol. 25, Pt. 1, No. 73.

Description: This paper describes a modified development method for analyzing claims experience and calculating claim reserves and liabilities on short-term health insurance benefits. It identifies many of the influences on claim development and discusses various ways to recognize them. From Transactions of Society of Actuaries 1989, Vol. 41.

Description: This paper examines five alternative valuation methods - prospective, retrospective, global, intermediate, and static - for the proper application of GAAP to Medicare supplement insurance. The focus of this paper is on the changes to expected future claim costs due to changes in the Medicare deductibles.