Description: Although rate structures where low-cost cohorts subsidize high cost cohorts may be justified from a actuarial, marketing, or legal standpoint, the subsidization creates risks which must be understood and monitored. This article presents the concept of subsidization signature to measure and interpret the effects of rate subsidization, and to assess the sustainability of rating structures and the sensitivity of business mix assumptions.

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 discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

Description: In this article, the author discusses the considerations and advantages of implementing an integrated enterprise risk management program for a health insurance company, and presents a summary of Aetna's experience with ERM as a case study.

Description: European insurance regulation pretends to capture and rely on the 1-year 1-in-200 VaR. But there cannot exist any scientific calibration of such measure. Why?