Description: This article provides a detailed description of the unbalanced subsidy provisions in the Affordable Care Act with easy to follow numerical illustrations. An understanding of the illustrative calculations is necessary to understand the subsidy implications. The article highlights some surprising and likely unintended results that will be interest to issuers, employers, consumers, regulators and policymakers. Actuaries can add expertise to their clients and to the public discussion with a proper understanding of the subsidy calculations and the resulting implications.

Description: Presented at October 1985 Annual Meeting. This session discussion is about trends in utilization review 'UR', preadmission certification, concurrent review, discharge planning, retrospective review, considerations in the design or purchase of UR services, normative data and monitoring UR, recent experience of UR programs and future expectations.

Description: Panelists discuss employers' perspective of defining strategies to identify best-in-market opportunities. From the Record of the Society of Actuaries, Vol. 24, No. 1.

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 October 2001 Annual Meeting. Panelists provide insight into the factors driving the cost increase of prescription drugs and how these factors are being addressed. Strategies include drug utilization review, manufacturer contracting, benefit design, formularies, pharmaceutical pricing, therapeutic substitution, physical education, and introduction of new pharmaceuticals. Also discussed are pharmacoeconomic benefit considerations when studying integrated medical and pharmacy expenses.

Description: Discusses cost-benefit decision-making for acquiring electronic data-processing equipment and installation issues, ability of small companies to compete in pension trust arena, effectiveness of various agency compensation programs in stimulating sales and improving persistency, success of sales to substandard risks and rating methods, and pricing, reinsurance and experience with individual hospital and medical policies.