Description: Many executives are talking about predictive analytics uses in health insurance.

Description: A discussion of an alternative valuation methodology which addresses many of the shortcomings of the current valuation system for U.S. life and health insurers one of which is the proliferation of undesirable variations in state requirements. Issue No. 37

Description: In 2007 the International Accounting Standards Board IASB released a discussion paper proposing a new accounting model for insurance contracts, known as the current exit value model. One aspect of the proposed accounting model is that claim liabilities would need to include explicit margins satisfying certain criteria. Currently it is common for U.S. medical insurers to include explicit margins in their claim liabilities. However, we demonstrate that the margin approach most commonly used today by U.S. medical insurers does not satisfy the objectives articulated in the IASB discussion paper regarding the role of margins. We then propose a new formula for including explicit margins in U.S. medical insurance claim liabilities in a manner that is more compatible with the principles articulated in the IASB discussion paper. Finally, we illustrate our proposed claim liability formula using an example drawn from real-life data.

Description: Presented at October 2000 Annual Meeting. Discusses prescription cost trends, factors behind the trends, and cost management strategies for both the commercial and Medicare markets.

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 process of setting initial and renewal premium rates for small group medical block of business using risk characteristics. Presents three pricing schemes and compares profitability Following the Curve, Lowest Best Rate and Highest Worst Rate.

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: Health Watch, Issue 79, December 2015, Health Watch

Description: Presented at October 2001 Annual Meeting. Panelists provide insight into the factors driving the cost increase of prescription drugs and how these factors are being addressed. Strategies include drug utilization review, manufacturer contracting, benefit design, formularies, pharmaceutical pricing, therapeutic substitution, physical education, and introduction of new pharmaceuticals. Also discussed are pharmacoeconomic benefit considerations when studying integrated medical and pharmacy expenses.

Description: Presented at June 1996 Spring Meeting. This discussion looks at how a managed care plan can know whether it is doing a good job on utilization review, if there is room for further reduction in utilization, and how a plan should prevent under-utilization.