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

Description: An analysis of the 1999-2011 experience of all Blues plans of betweeen $1.8 and $3.8 billion in annual revenue in 2010 to determine if there is any empirical evidence of an industry underwriting cycle. The analysis shows there is no such evidence.

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: 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: Discussion of how to mature value-based contracts between health insurers and provider organizations to improve population health and financial sustainability. Centers around contract parameter consistency, revenue predictability and risk assessment. Intended audience are health plan and ACO actuaries and leaders. Authors are writing from the provider perspective in value-based contracts.

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 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: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: Presented at September 1995 Valuation Actuary Symposium. Discusses the Health Organization Risk-Based Capital formula.