Description: The article explores how integrating AI into insurer apps can address critical challenges in healthcare, such as patient no-shows, medication adherence, and cost management. These non-disruptive approaches aim to increase the effectiveness of patient interventions and improve medication adherence.

Description: Read this report to learn more about interpretable machine learning techniques for health insurance fraud detection.

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: This article describes Medicare Supplement and short-term care products in more detail, and we compare their risk profiles. We explore the concept that these two products—when offered together—may provide a complementary hedge of certain policyholder behavior risks.

Description: The always popular Medicaid Hot Topics session is back with discussions from an expert panel on the most riveting Medicaid topics of the year. These could include the following: • Medicaid Fiscal Accountability Proposed Regulations• Tennessee's Block Grant Proposal• ACA court battles: What are the potential impacts on Medicaid? • Pass-through payments are converting to directed payments: What is changing?• And more current topics of interest to Medicaid actuariesMedicaid is dynamic and it is difficult to stay current on all of the changes. This session provides insightful discussion into the major changes that impact actuaries and their companies or state clients.

Description: While intended to assist health plan actuaries responsible for stress testing and ORSA filings, this session will also be informative for actuaries interested in communicating the impact of potential catastrophic events for health plans to their management and board. It will begin with a discussion of event thresholds for stress tests and their impact on capital and financial statements. Presenters will take a detailed look at several catastrophic event case studies (historical and hypothetical) in the following areas: healthcare specific (e.g. pandemic, specialty Rx), financial institution/credit market, operational/business, strategic and multi-event scenarios.</

Description: Part II of a two-part series discussing individual market evolution from before the ACA through President Trump's first term.

Description: This paper will examine why CSR defunding produces pricing uncertainty and how regulators can alleviate these risks when insurers price 2020 premiums.

Description: WeChat is gradually becoming the main force of insurance online marketing for insurance products in China.

Description: Read the October 2018 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Joe Wurzburger, Staff Fellow at the SOA, shares his views and insights about the health care industry in general and the Health Section&#39;s role in particular.

Description: Read the February 2018 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Read the June 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Joe Wurzburger, Staff Fellow at the SOA, shares his views and insights about the health care industry in general and the Health Section&#39;s role in particular.

Description: This article is an interview with an actuarial leader.

Description: Read the March 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Joe Wurzburger, Staff Fellow at the SOA, shares his views and insights about the health care industry in general and the Health Section&#39;s role in particular.

Description: The article discusses the sustainability of the ACA individual market from a public entitlement standpoint. A key point of measuring sustainability is the reliance on market forces rather than federal budget constraints. The article explains why an actuarial viewpoint of sustainability is necessary to a greater extent than other public assistance and social insurance programs. The article challenges actuaries to be a bold, objective voice in a space that is full of opinionated but often uninformed viewpoints.

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

Description: Review of 2015 from perspective of the Health Section

Description: Essential Health Benefits and Actuarial Value

Description: Profile of the Health Section.

Description: Interviews with several actuaries who are subject matter experts in the health field to get their perspectives on implementing the Affordable Care Act (ACA).

Description: May 2013 issue of the Health Watch newsletter

Description: October 2012 issue of Health Watch newsletter

Description: Explanation of Medicare Advantage STAR rating program as it relates to payment rates for MA bids. Also describes important features of the program from an actuarial perspective, how the components of the STAR rating are calculated and implications and considerations for actuaries.

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: This report describes the results of a survey on reflecting risk in pricing. The survey expands on one conducted in 2003 and was expanded to include life, health, P&amp;C, and non-North American insurance companies.

Description: A research report that first defines ERM and provides the results of an applicable literature search with hyperlinks and then describes the current state of Enterprise Risk Management practices for health organizations. Areas covered: 1. Operational Risks. 2. Balance sheet risks. 3. Pricing discipline. 4. Asset risks. 5. Learnings. 6. Emerging risks.

Description: An essay discussing universal access to high quality, low cost health care.

Description: Essay discussing cost, quality and access of healthcare and then describes the need for rationing.

Description: A call for essays issued by the SOA Health and Long Term Care Sections on the visions for the future of the U.S. health care system.

Description: The paper focuses on value creation for European health insurance companies through the practical application of integrated ERM frameworks.

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: New technologies have created alternative treatments to improve vision and hearing. What are these technologies and their cost? Can these procedures be insured? What is the cost impact if covered? From the Record of the Society of Actuaries, Vol. 31, No. 2, Session 86

Description: Panelists discuss consumer-directed health plans [CDHPs], describing: [1] plan design, how they work, and pricing considerations, [2] various reserving issues, and [3] the current and future marketplace for the products. Session 43PD of the 2005 Valuation Actuary Symposium.

Description: This is a highly interactive role-playing session detailing the actual product development process for a hypothetical health care product. From Record of Society of Actuaries, Vol. 30, No. 3, Session 19

Description: Panelists discuss recent acquisitions and mergers from a variety of perspectives. From the Record of the Society of Actuaries, Vol. 30, No. 3, Session 90

Description: This presentation is a panel discussion, session 54PD, from the 2004 Spring Meeting of the Society of Actuaries, held June 14-15 in San Antonio, TX. This session covers the impact of segmentation and underwriting on expected mortality and morbidity. Panelists discuss the importance of data mining and customer selection on ultimate experience, setting up direct marketing applications with the right type of questions to maximize responses but limit risk, the use of prescription drugs and other databases, and industry practices for obtaining customer information. Discussion from participants is included. From the Record of Society of Actuaries, Volume 30, No. 2.

Description: Measurement and benchmarking of surplus levels provide health plans with valuable insights regarding their financial strength and performance. This session discusses target surplus and reserves for health plans. From Record of the Society of Actuaries, Volume 30, No. 1, Session 50

Description: Panelists lead participants in a discussion of recent experiences and current issues regarding the valuation of medical and dental insurance and managed care products. Topics include ASOP 22 [asset adequacy analysis for statements of actuarial opinion] and ASOP 41 [communication]. From the Record of the Society of Actuaries, Volume 29, No. 2, Session 102

Description: Topics to be discussed include various regulator and industry benchmarks, comparative data on capital and surplus levels among health carriers, and capital allocation and modeling techniques used to assign capital to various lines of business. From Record of the SOA, Vol. 29, No. 2, Session 20

Description: Paper on the number and growth of the uninsured and underinsured in health insurance. Reviews literature on the following items trends in the number of uninsured, state policy activities, disparities in access, health care access and the health care safety net.

Description: Panelists discuss the contractual relationships between health-care providers and health-care insurers [payers], and how they can be improved. Discussed are managed care, HMO, and PPO types of negotiated contracts in the private arena. Recent trends in types of provider arrangements, and expectations for the future, are also discussed. From the 2002 Record of Society of Actuaries, Volume 28, No. 3. Session 97PD of the Boston Annual Meeting.

Description: Experts discuss new strategies related to provider contracting and network management. Topics include various reimbursement approaches and risk-sharing arrangements, unique risk arrangements for certain provider specialties, unique risk managements for specific diseases, and the role of care management/care coordinators. From the 2002 Record of Society of Actuaries, Volume 28, No. 2. Session 59PD of the San Francisco Spring Meeting.

Description: Attendees gain exposure to various approaches for effective surplus management for health entities. From the Record of the Society of Actuaries, Volume 28, No. 2, Session 91

Description: Panelists and audience members give their views on health-insurance topics including recent large claims experience, frequency and severity components of large claims trends, pricing, reserving, and the outlook for the future. From the 2002 Record of Society of Actuaries, Volume 28, No. 2. Session 79OF of the San Francisco Spring Meeting.

Description: Actuarial appraisal and role of the actuary with regards to Health Insurance Mergers and Acquisitions. Issue No. 40.

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: This article discusses health care reform in Kentucky. In 1994, Kentucky implemented health care reform measures inspired by the unsuccessful attempt at national health care reform in the Health Security Act of 1993. The measures adopted in Kentucky are described by the author as &#39;a textbook case of how not to engage in health care reform.&#39; From: The Actuary, April 2000 – volume 34 - Issue 4.

Description: Panelists discuss various managed care strategies and their experiences with how well these strategies have been implemented in the individual and small group market. From the Record of the Society of Actuaries, Vol. 25, No. 2.

Description: This article explores the trend in mergers and acquisitions among health insurance providers including the rationale for the recent increase in activity.

Description: Panelists discuss different aspects of self-selection among Medicare options. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: Panelists report on the status of activities by national associations in regard to risk-based capital requirements for health insurers. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: Panelists discuss the role of the valuation actuary in health insurance. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: 1998 Valuation Actuary Symposium. The speakers presented a case study on long-term-care gross premium valuations, GPV from an individual disability income perspective, and a case study for a medical GPV.

Description: Panelists at this session of the SOA 1997 Palm Desert Spring Meeting present various physician incentive programs, including withholds, bonuses, capitation, and other risk-sharing concepts. Implications and effectiveness of each type of program and appropriate situations for applying each program are discussed.

Description: Presented at October 1996 Annual Meeting. This session presents and discusses the NAIC&#39;s model bill for risk-based capital as it relates to health insurance.

Description: At this presentation from Session 6PD of the SOA 1996 Colorado Springs Meeting, the panelists discuss the role of the valuation actuary in health insurance. The focus of the session is scenario testing in health insurance and how this is a tool in assessing the risks of the company. Statutory minimums and statements of opinion are discussed. From the Record of the Society of Actuaries, Vol. 22, No. 2.

Description: This paper examines the financial dynamics resulting from the currency exchange rate for medical insurance products that are denominated in a currency different from that in which covered medical expenses are incurred. From Transactions of Society of Actuaries 1995, Vol. 47.

Description: This panel will discuss the current status of NAIC activities with respect to risk-based capital RBC. The potential impact on financial reporting with respect to health products, specifically, indemnity, HMO, disability, and nontraditional products will also be discussed. From the Record of the Society of Actuaries, Vol.21, No. 4a.

Description: Panelists at this session of the SOA 1995 Vancouver Spring Meeting debate the pros and cons of Medical Savings Accounts [MSA]. Viewpoints on the effectiveness of MSAs, expected changes in medical consumer behavior, anticipated cost savings, and other topics are discussed.

Description: This session from the 1995 SOA Vancouver Meeting reviews capitation arrangements in health insurance, the reasons for capitating providers, capitation formulas, cost reduction strategies and the role of the actuary in evaluating experience for capitation. From the Record of the Society of Actuaries, Vol. 21, No. 3a.

Description: 1994 SOA Meeting, San Antonio. This session was about provider network building in nonmetropolitan areas. Question addressed: 1. How can an effective delivery system be built to serve rural areas? 2. What influence will health care reform have on such systems? 3. Does a single-payer system make sense for such populations? 4. How does health care reform impact nonmetropolitan markets?

Description: 1994 SOA Spring Meeting, Orlando. In this session the panel consider the question of uncertainty in loss reserves including discussion of sources and measurement. The panelists analyzed the same data set from different perspectives and discussed the strengths and weaknesses of the approaches.

Description: This session from the 1994 Valuation Actuary Symposium covers financial projections of health coverage including the distinction between short-term and long-term projections and and overview of the handbook entitled The Dynamic Financial Condition Analysis Handbook which focuses on dynamic solvency projections.

Description: This session from the 1994 Valuation Actuary Symposium covers long term care and health related issues for valuation, an update from the Risk-Based Capital Task Force of the Academy on developing a risk-based capital formula for health coverages, an overview of the health practice notes.

Description: This session is about individual medical and regulatory issues, loss-ratio requirements, form and rate approval, compliance and reporting issues. From Record of Society of Actuaries Vol. 19, No. 4B.

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: This session is about appointed actuary issues for the health actuary including cash-flow testing, asset valuation and risk-based capital. From Record of Society of Actuary Vol. 19, No. 4B.

Description: 1993 SOA Spring Meeting, San Diego. This session was about the Latin-American insurance market. Topics included: 1. Size, growth, regulations, products, distribution, marketing. 2. Market entry, business strategies, cultural issues, local staffing. 3. Level of activity for U.S. companies.

Description: This session from the 1994 Valuation Actuary Symposium focuses on long-term projections of health insurance, the uses of the projections, the type of model to use and model considerations for the projections.

Description: This session will discuss the role of actuaries under national health insurance, role of the Canadian health actuaries under that national program and how actuaries can shape the health-care environment in the U.S.. From Record of Society of Actuaries Vol. 18, No. 4B.

Description: 1992 SOA Regional Meeting, Anaheim. This session addressed the product management actuary and the product management process. Topics discussed : 1. The monitoring of the environment and how that monitoring leads to the generation of ideas. 2. Consideration of how those ideas are affected by distribution, marketing, and organizational issues. 3. The setting of assumptions. 4. How to get different areas of your company to work together, and ways to bring the product to market as quickly as possible. 5. How to manage business once your company places it on the books.

Description: This 1991 panel discussion is about mid-size and large group medical issues, including: 1. Managing the underwriting cycle, 2. Effectively managing the risk, 3. Controlling medical costs, 4. Financial arrangements offered to control or shift risk [i.e., Administrative Services Only [ASO] and minimum premium contracts], and 5. The effect of the Resource-Based Relative Value Schedule [RBRVS] on provider fees and plan costs. From the Record of the Society of Actuaries Vol. 17, No. 4A.