Description: Presented at June 2002 Spring Meeting. This session discusses how credibility varies by size of groups for various health coverages, when a block of business can be considered fully credible, how credibility can factor into a rate filling, and to what extent current experience can be considered more credible than past experience.

Description: This paper presents population hospital utilization data concerning the proportion of total hospital days that is due to injury and the proportion of total hospital days that is spent in intensive care units for use in obtaining reserve factors. The paper also presents continuation data for hospitalizations. From Transactions of Society of Actuaries 1979, Vol. 31.

Description: Chapter 2 analyzes, in table form, the study's claimant counts and charge totals, broken down by gender, age, diagnosis category, year, and by subscriber vs. dependent status. From Group Medical Insurance Large Claims Database Collection and Analysis, M-HB97-1.

Description: Health care has changed rapidly over the past couple of years. The pandemic has shifted consumer behavior in how and where they receive health care as well as consumer attitudes toward health care. Payers continue to design innovative solutions in responses to their patient’s needs and expectations. These changes in consumer behaviors and the responses by payers are expected to impact both health care cost and utilization. Discuss changes in health care that have emerged due to the pandemic and how they are expected to influence actuarial assumptions. Explore epidemiological models commonly used in the industry, the considerations when using these models, as well as the challenges with regards to gathering and interpreting relevant experience data. By attending this session, you will be able to: Identify shifts in consumer behavior that have emerged from the pandemic and describe how payers are responding to new patient expectations. Discuss how these post-pandemic changes by consumers and payers influence medical spending. Determine which actuarial assumptions are impacted and how and if the impact is expected to be temporary or permanent. Discuss considerations taken by actuaries and challenges faced when modelling actuarial assumptions post pandemic.

Description: CPT, NCCI, ICD, CCI, DRG, APC, PTP – understanding healthcare claims involve a dizzying array of code sets and payment methodologies, and yet the claim form is the intersection of health plan affordability, provider payment, and data analysis. This webcast will cover: • The code sets used in medical coding • Types of correct coding policies implemented by CMS and commercial payers • Payment integrity strategies to drive health plan affordability • Data analytics approaches leveraging medical coding knowledge

Description: This article provides an overview of critical illness insurance: history, product description, and the three primary ways to offer critical illness coverage in the United States. This article also contains an illustration of an issue age premium rate calculation, as well as product features and rating applications specific to the various types of critical illness coverage.

Description: Analysis of possible mathematical relationships between hospital quality and hospital billed or allowed charges or other measures, using quality data as defined by the U.S. Department of Health and Human Services along with the Hospital Quality Alliance for their Hospital Quality Initiative.

Description: With the mandated health plan transparency files, health plans and providers are now able to substantially enhance their provider contracting efforts. Although the files are large and cumbersome they are market disruptors and provide new insights for provider contracting efforts. Explore a demonstration on the type of information now available and how it can be used to enhance this from both a health plan and health care provider perspective.

Description: Focus on how innovative health care organizations develop their value proposition for their intended buyers. Presenters will share information about their specific solution and the methods used to derive credible savings estimates, ROI, and performance guarantees. Learn about data utilized, the methods deployed, advantages, disadvantages, and buyers' reaction. This session is expected to be technical, highly informative, and interactive with audience members.

Description: The COVID-19 pandemic has had an impact on all aspects of daily life and its impact extends to how disability incidence may play out in the future. Product profitability will be shaped by how morbidity patterns, interest rate levels and other key drivers will play out into the future. In this session, our panel will discuss COVID’s impact on IDI morbidity experience as observed over the past 18 months, offer comparisons and insights in light of other insurance lines of business, and share emerging information on the on-going effects of Long COVID. Highlights will also include how regional differences and implications for insurers as the industry moves further into the COVID vaccine era.