Description: Evaluation of Taiwan's National Health insurance program and a discussion of a managed competition model to reform it.

Description: The Brazilian private health care market ended 2010 with US $48 billion worth of premium. This already makes it Latin America’s largest health care market and sixth in the world ranking. This article provides information on the market and opportunity for growth.

Description: Mental health spending has reached $147 billion in the United States with demand only increasing greatly impacting society as nearly 1 in 5 experience these issues. There are even more indirect costs associated with mental health causing a national crisis surpassing 1 percent of the GDP. These costs coupled with the severe lack of licensed clinicians calls for an innovative solution. Through years of development and completion of a randomized controlled trial, Prevail has built and validated a low-cost, scalable solution. Prevail's clinically proven digital mental health treatment provides increased access to care while reducing overall health costs. Private and public payors should being reimbursing this model and offering it to their members.

Description: Explanation of Medicare Advantage STAR rating program as it relates to payment rates for MA bids. Also describes important features of the program from an actuarial perspective, how the components of the STAR rating are calculated and implications and considerations for actuaries.

Description: The authors explain a grassroots model for health-risk pooling that is being used in India. They explain why traditional health insurance models have not worked in this context.

Description: The winner's curse, applied to Affordable Care Act plan pricing.

Description: This session discussion is about tools, techniques, and methods used by the health valuation actuary HVA in dealing with business projections, cash-flow analysis, valuation on nonguaranteed premium business, target surplus analysis, reinsurance and claim reserves. From Record of Society of Actuaries Vol. 18, No. 1A.

Description: Presented at April 1986 Spring Meeting. This session discussion is about participation in alternative delivery systems, direct contracting with medical providers, participation in coalitions, employer demands for data, employer selection criteria for health carriers.

Description: The PPACA imposed a market share-based health insurance provider fee, known as the "Section 9010 Fee", "Health Insurer Fee", or simply the "HIF", on each “covered entity” with net premiums written in excess of $25 million that is engaged in the business of providing health insurance coverage for U.S. health risks. This article provides background information to help unpack the language behind the Section 9010 Fee and highlights a few areas of special interest including merger and acquisition-related issues, application of the Section 9010 fee to expatriate plans, and considerations regarding fee administration.

Description: Panelists discuss HMO open access plans [in-network-only coverage, but no referral requirements] and the provider contracts and administrative systems that are needed to support them in a cost-effective way. From the Record of the Society of Actuaries, Vol. 25, No. 2.