Description: This paper proposes a hypothesis that the negative public policy implications of durational rating strategies in the medical insurance market are caused by lack of prefunding of durational deterioration of experience and constitute a failure to maintain an important part of the original insuring promise. To solve the problem, a practical and simple reserving basis is proposed as a regulatory standard. Discussions of this paper are included.

Description: Presented at October 1985 Annual Meeting. Discusses 3 papers: 'Report on Reserve Standards for Individual and Group Health Insurance Contracts' by the AAA Committee on Health, 'Reserve Principles for Individual Health Insurance' by the Committee for Accident and Health, and 'Structure for Consideration of Health Coverage Valuation Standards' by an NAIC Health Subcommittee of Standing Technical Advisory Group.

Description: 1962 SOA Regional Meetings, Jacksonville and Chicago. This is a discussion about statutory reporting issues surrounding group term and group accident and health insurance. From Transactions of Society of Actuaries 1962, Vol. 14 Pt. 2.

Description: The American Academy of Actuaries task force charged with developing a risk-base capital formula for health insurers submitted its preliminary report to the NAIC Health Organizations Risk-Based Capital Working Group.

Description: This session discussion is about tools, techniques, and methods used by the health valuation actuary HVA in dealing with business projections, cash-flow analysis, valuation on nonguaranteed premium business, target surplus analysis, reinsurance and claim reserves. From Record of Society of Actuaries Vol. 18, No. 1A.

Description: Intended for actuaries interested in understanding more about the Medical Loss Ratio and the impact Quality Improving Activities (QIA) and fraud reduction expenses have on the rebate calculation. This session will focus on what expenses qualifies as QIA, examples of programs from major carriers, current regulations and the differences between commercial, and Medicare, and Medicaid requirements.

Description: After the bid process, desk review, rebate reallocation, an “enjoyable” audit, and open enrollment; the Medicare plan year starts. Throughout the year, organizations find it pertinent to get an accurate picture of their Part D liability as reinsurance, LICS (Low Income Cost-Sharing) subsidy, and risk corridors are accrued. Attendees will learn about the basics of Part D accruals, how future accrual amounts are estimated based on patterns in the data, and how bid assumptions versus actual results impact plan sponsor profitability. We will also discuss financial statement treatment of these items. Real-life examples from bids to outcomes will be provided to enhance the discussion. Ultimately, attendees will come away with a deeper understanding how their bid assumptions play out, and how they can use Part D accruals to plan for future bid development.

Description: Preparing an effective actuarial memorandum in support of the health actuarial opinion.