Description: This article discusses new opportunities for states to waive certain marketplace requirements of the Patient Protection and Affordable Care Act. The article focuses on specific opportunities for states and the role that actuaries will play.

Description: Discussion of the impact of the ACA on RBS and required surplus for a health plan

Description: Discussion of anticipated marketing and pricing considerations of Group Insurance in the 1980's including: a. Regulatory environment including National Health Insurance b. Economic and growth potential c. Competition including Health Maintenance Organizations d. Technology e. Evolving role of employee benefits f. Products g. Pricing considerations h. Marketing approaches Also, discussion of the 1960's and the 1970's a. Major influences b. Benefit changes c. Alternate funding approaches 2. The 1980's environment a.

Description: The medical scheme approach adopted by several African countries has failed to meet the needs of those in informal employment and rural communities. This is partly due to affordability amongst these individuals as well as a lack of awareness of how healthcare financing products work. Community based healthcare organisations have achieved greater levels of success in this regard by carefully incorporating the peculiarities of communities in benefit design and involving community members in the management of these healthcare solutions. There are lessons to be garnered from the countries where these have been implemented with some level of success. Even as countries aim towards universal health coverage, observing the unique needs of different communities within a country is essential to ensure resources are utilised efficiently and that healthcare needs are targeted effectively.

Description: This article contains excerpts from the first three articles that were released through the strategic initiative - Commercial Health Care: What’s Next?

Description: This session is about regulatory constraints and the role the NAIC is playing to help facilitate 24-hour programs, plan design issues, the use of managed care, coverage as part of a workers' compensation plan versus coverage of health care outside of the workers' compensation system. From Record of Society of Actuaries Vol. 18, No. 4A.

Description: This article compares the Prescription Drug Plan (PDP) market to the commercial individual market exchanges included in the Affordable Care Act. PDP carrier actions to date could help predict certain aspects of the exchange market.

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: 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: Profile of the Health Section.