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

Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: In an effort to build a bridge between epidemiological and actuarial modeling, this paper analyzes possible financial arrangements made against expenses resulted from medical treatments given to insured patients. Based on classical compartment models, the first part of this paper designs insurance policies for susceptible participants facing the risk of infection and formulates the financial obligations of both parties using actuarial methodology. For practical purposes, the second part employs a variety of numerical methods for calculating premiums and reserves. The last part illustrates the methods by designing insurance products for the Great Plague in Eyam and the SARS Epidemic in Hong Kong.

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: This article explores the changing risk profile between the transitional Affordable Care Act (ACA) period (2014-2016) and under the final ACA period (beyond 2017) for the individual market. Actuaries are in a unique position to help facilitate the change from the current ACA period to the final period when health plans will have to take on substantially more risk.

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: A dicussion of the Rate Classification Actuarial Standard of Practice, ASOP #12: its purpose, its scope, guidance, and examples.