Description: In this, the second step, Sibson engaged the vendor and actuarial communities to solicit input on the actuarial model for determining the impact of various environmental, lifestyle and behavioral risk factors. The goal was to understand the extent to which actuaries currently use models around wellness, refine the above conceptual model, and better understand the potential uses of, and value to, the actuarial and vendor communities that would use such a model. We sought to understand the potential applications and sources of data for the actuarial model. We gathered input on how the model would best suit the professional needs and help shape the future role of the actuary. Lastly, we gathered feedback on the above conceptual model.

Description: Submission components, format and considerations.

Description: Individual Market and ACA Products Actuarial rating principals

Description: CLASS Act and ACA

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

Description: This article will consider several issues arising from ACO budgeting and pricing of stoploss coverage, including: 1) attribution of members; 2) claim carve outs; 3) ambiguous stoploss terms; 4) providers gaming the system and 5) credibility of data.

Description: On January 1, 2014, many states will be enrolling newly eligible parents and childless adults into the Medicaid program. This article compares the expansion population to the current Medicaid population.

Description: This article begins with a comparison of the commercial risk adjuster to the exisiting Medicare model, and goes on to discuss why the existing strategies employed by health plans will not work in a risk adjusted environment. The article elaborates on the importance of diagnosis coding, controlling member mix, and care management in order to mitigate risks and gain from newly created opportunities.

Description: This Society of Actuaries Research Brief has been constructed to highlight some of the key features of the epidemic and contemplate the risks for the actuarial profession to consider in their work.

Description: This paper highlights the menace of overweight and obesity which are on the rise. Health care systems and insurance industries are directly affected. Liability claims are on waiting. The food related damage claims are costly. Insurers are therefore driven to find a solution: classify overweight and obesity as a group, adjust their premium to reflect the cost, and justify the classification and the adjustments.