Description: In this webcast, presenters will outline the key content in ERM ASOPs 46, 47 and 55 and explore the impact each ASOP has on practitioners working in these fields. We will also describe the revision work currently under way in the ERM Committee of the Actuarial Standards Board.

Description: The COVID-19 pandemic has had an impact on all aspects of daily life and its impact extends to how disability incidence may play out in the future. Product profitability will be shaped by how morbidity patterns, interest rate levels and other key drivers will play out into the future. In this session, our panel will discuss COVID’s impact on IDI morbidity experience as observed over the past 18 months, offer comparisons and insights in light of other insurance lines of business, and share emerging information on the on-going effects of Long COVID. Highlights will also include how regional differences and implications for insurers as the industry moves further into the COVID vaccine era.

Description: This is the abstract for the paper entitled 'Pricing Long Term Insurance Contracts.' This paper considers several models describing the changes in the needs of the insured for care over time. From Actuarial Research Clearing House 1994, VOL. 1.

Description: Employers, health plans, stop-loss insurers and reinsurers are all affected by the high cost of treating cancer. In recent years, cutting-edge pharmaceuticals, bone marrow transplants and CAR-T cell therapies have driven very high cost trends for cancer, with more emerging therapies on the horizon. In this session, we will review these new treatments, showcase models that aid in understanding the range of likely financial effects of the current, expanded, and likely-to-be approved indications for cell therapies that will treat certain patients affected by lymphoma, leukemia, and multiple myeloma. This session will explain important considerations for modeling Medicare, Medicaid versus commercial populations, key risk concerns caused by the size of enrollee pools, and important differences between the various therapies that affect modeling. We will also discuss averted cost, health outcomes, pricing levels, and risks caused by provider billing practices.

Description: Actuaries historically modeled new launches in pharmaceuticals by anticipating the expected change to the market basket. This became more complicated with the recent launches of gene and cell therapies as they address rare diseases. Rare conditions have low total member volume to study and some do not currently have a diagnosis code to identify them within claims data. Addressing this modeling challenge has been growing more important in the recent years with the number of therapies launching. What has the health care industry, and more specifically health care, done to enhance modeling and how should this be altered for the future? Additionally, historic modeling has sometimes incorporated a level of direct medical treatment cost offsets where studies have shown lower treatment costs are achievable. Can gene and cell financial modeling include cost offsets as well? And if so, what are suggested precautions or limitations to this effort?

Description: This report outlines the current wellness environment, the objectives of the wellness study and provides a summary of the overall study findings. This report is supplemented by the Research Summary Report, Survey Results, and Interviews with Researchers. This document includes a summary of key findings from each of the three phases.

Description: In this paper, the authors created a mathematical model which reflects typical relativities by age, duration of disablement, and deferment period for disability risk. The paper is followed by discussions submitted by various reviewers.

Description: This paper examines four and-a-half years of prescription records for an elderly population who have relatively comprehensive out-of-hospital drug coverage under the Pharmaceutical Assistance Contract for the Elderly program in Pennsylvania. The result is a discussion of the determination of non-parametric estimations of the distributions. From Actuarial Research Clearing House 1991, Vol 1.

Description: This paper develops a formal framework to model the behavior of individual and small group health insurance policies in a competitive market. In this framework, anti-selective lapse is not assumed, but arises as a result of rational consumers seeking the best value in a competitive market where the premium rates are restricted by law. The authors obtain a model that addresses a number of fundamental questions which have not been fully answered previously, including the effect of price-induced anti-selective lapse on the mix of insureds in a block and the optimal renewal price to maximize the aggregate profit of a block.

Description: Level funded products often target the small group market (2-50) and can result in many manual and tedious processes for underwriting to perform risk assessment. Learn how a carrier used technology to help automate risk assessment without the need for paper medical questionnaires, and exposed a risk engine for broker quoting to enable near real-time of pricing for risk-based products. The approach reduced labor and allowed underwriting to focus solely on fallout cases while also improving pricing consistency. Discuss broader trends in the health market for risk assessment, including new machine learning cost predictions that can be used for automation and better predictions of future costs. Discussion topics will include underwriting guidelines, business rules, risk scores, and machine learning. By attending this session, you will have a better idea of new trends in risk assessment for small groups where no claims experience is available. And, better understand business rules that are common in underwriting for flags for review as well as how risk scores and machine learning can be used during the underwriting process.