Description: This report provides morbidity experience under Individual Loss-of-Time policies, 1974-1975.

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: More and more providers are desiring risk-based contracts instead of traditional FFS-based contracts. This session is intended to outline some of the actuarial best practices in risk-based contracting related to the many flavors of the CMS ACO programs, as well as Commercial risk-based contracts.

Description: This paper presents a method involving re-sampling 'with replacement but without random numbers', numerical convolutions for sums and quotients, and estimation of confidence intervals for trend in average size claim. In this paper, this method is applied to major medical claims.

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: Presented at September 1994 Valuation Actuary Symposium. Discusses analyzing and projecting financial risk in group health plans.

Description: This paper develops net claim costs for each major type of dental service, using experience data under group dental contracts covering 250,000 persons from 1974-1977. From Transactions of Society of Actuaries 1979, Vol. 31.

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: In this article, the author discusses the Georgia Uninsured Working Group and their recommendations on solutions for the uninsured in Georgia through new HRA/HSA laws. Issue No. 59

Description: This article relates the health insurance industry to baseball retain & grow business while making a profit, competition, additional product offerings, evaluating risks. Issue No. 59