Description: Learn about key actuarial and analytic tools and methodologies used by commercial health insurance to identify and quantify drivers of healthcare cost and utilization (including wasteful and low-value ones) and risks. Use case scenarios in which these tools and methodologies apply, such as underwriting, reinsurance, medical management for population health and chronic diseases, managed care contracting, insurance market reform, provider payment reform, etc., will also be covered. Experience from the U.S., China and other parts of the world will be shared.

Description: This presentation uses a combination of lecture, case studies and computer modeling to introduce various approaches to estimation of Incurred But Not Reported IBNR liability. .From Record of Society of Actuaries, Vol. 23, No. 1.

Description: This discussion at the SOA 1966 Annual Meeting is about various aspects of group life and health insurance including disclosure forms, interest rates, group life maximums, disability insurance, and Medicare.

Description: This general discussion looks at mortality experience with the advent of CSO tables, annuity premium tax, termination dividends, classes of agents included under Social Security, and conditions affecting companies entering the fields of disability income, accident, health, hospitalization and medical insurance.

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.

Description: MHPAEA prohibits health plans from imposing financial requirements or treatment limitations on behavioral health benefits that are more restrictive than those applied to medical and surgical benefits. MHPAEA's regulations define treatment limitations to include nonquantitative treatment limitations (NQTLs), which are benefit design features that are not numerical, but otherwise limit the scope or duration of benefits.

Description: HIV is still a big public health concern, but there are therapies available to prevent infection before and immediately after exposure. As legislatures and the USPSTF considers adding these therapies to the list of preventive care covered without cost share, actuaries will need to estimate the impact on their care cost. The presenters will share an actuarial tool kit to estimate the impact of covering PrEP and PEP for different populations. Examples are provided and discussion is welcome.

Description: The evolving specialty pharmacy environment has created difficulties for actuaries pricing and forecasting pharmacy coverage. Unpredictable specialty pharmacy trends have increased insurers' earnings volatility and affected members' health care affordability. The presenters will highlight the current specialty drug development pipeline and explore specialty pharmacy drug trend management strategies. They will also provide concepts to help manage the coming wave of gene and cell therapies.

Description: Presenters will address optimal new business written premium mix at the firm and state levels under varying competitive conditions. They will explore the use of mean-variance optimization to determine a company's optimal new business written premium mix for a given geographical area, predicting statewide product mixes using varying rate regulation scenarios, involving profit caps and measuring/testing a market's competitiveness for a given line of business. The scope of the ideas to be presented is international, applying to property, liability, individual and group life; individual and group health; disability and accidental insurance. Examples will be presented for general insurance in the United States

Description: 2005 SOA New Orleans Spring Meeting. In this teaching session, panelists discuss the importance, performance, reading and understanding of research that is critical to the future of the health actuarial profession. A case study of a particular research paper is used to facilitate understanding.