Description: State Medicaid programs have broad flexibility to establish their own payment methodologies and rates for hospital services. Many states direct additional funding to populations, services, and hospitals where Medicaid comprises a disproportionate share of total business, or where there are other access concerns (e.g. rural providers). Actuaries can play a key role in determining where those additional funds would have the most benefit.

Description: A panel of leading reinsurance executivesprovide perspective on topics to include market capacity, cell and gene therapy, COVID-19's impact on results, syndication arrangements, mergers and acquisitions, and how reinsurers view a variety of risk transfer opportunities.

Description: Connect with the health actuarial community -- explore innovative solutions, advance your career, and participate in engaging, interactive events. Join the industry’s leading actuaries, analysts and professionals to network and discuss the impacts of the latest marketplace factors and trends.

Description: Connect with the health actuarial community -- explore innovative solutions, advance your career, and participate in engaging, interactive events. Join the industry’s leading actuaries, analysts and professionals to network and discuss the impacts of the latest marketplace factors and trends.

Description: Inspired by other financial savings products available to Canadians, this article describes a potential solution for financing future health expenses with the creation of a Registered Health Savings Account (RHSA). This solution has been thought on the basis of four premises : 1- Individual Accountability for Health Expenses; 2- Early Savings Leads to More Accumulation; 3-PreferredTax Treatment for Personal Health Savings; 4- Complementing current public and private health systems; Main elements of the RHSA are described (Contributions, Accumulation, Utilization of account, Management by financial institutions).RHSA'S expected balances and some other results under three scenarios (a person in good health, one in poor health, and one with unexpected death at age 45) are summarized in a table. Health expenses deducted yearly from RHSA's balance were estimated using total, per capita, provincial government health expenditures by age-band for Canada, in 2020, from the Canadian Institute of Heath Information’s (CIHI), which account for 71.8% of total expenditures, that is public + private. Thus 28.2% of total expenditures were used for private health expenditures, then forecasted to 2024 and projected using a 4% annual trend. Some objections to the solution explored were anticipated as well as some refutations to these objections.

Description: When designing and pricing a healthcare product, it is not only important to know how to model frequency and severity, but it is essential to understand human behavior. Of course, the issue of anti-selection in medical insurance is well known as individuals know more about their health and prior expenditures than an insurer does. This type of behavior is certainly rational, and to be expected.

Description: What are Biosimilar drugs? Are they the same as generic drugs? What potential impact might Biosimilars have in the United States prescription drug landscape and it’s economics? This article explores those questions as well as exclusivity and interchangeability.

Description: Learn more about Health Care Sharing Ministries (HCSMs) and their functionality as health insurance. These nonprofit companies pool money from participating members to assist with members' healthcare coverage. Further exploring HCSMs, some of the offered arrangements of this plan operate differently and with a unique regulatory framework. HCSM enrollment has grown 1000% since solidification as a law in the ACA. By signing up for this webcast, you can discover why HCSMs are becoming a key component of the individual market in some states.

Description: "The script is for a Medicare session by the Society of Actuaries, led by Danica Turner, which introduces how revenue works on Part D. It covers the various cash flows and subsidies that Part D plans receive, including direct subsidies, federal reinsurance, and low-income subsidies. The session also explains the different phases of coverage and the upcoming changes due to the Inflation Reduction Act in 2025. The goal is to provide a high-level understanding of the revenue and payment calculations for Part D plans.

Description: The health insurance industry has historically used several factors to develop premium rates. Many of these, e.g. gender rating, have been largely eliminated from health insurance rating practices by regulations as the Patient Protection and Affordable Care Act (ACA) because they were determined as inequitable. However, several other factors still remain as differentiators in premium rates charged to individuals and groups. In conjunction with the SOA, researchers studied whether there could be ‘ghost’ rating factors, like race, ethnicity, or socioeconomic status, that are inherently included in some of these remaining allowable factors. Review results and opportunities for future research. By attending this webcast, you will be challenged to think about traditional rating factors in a different way. Rather than focusing on whether certain factors are sound based on the underlying claims cost, this session will focus on whether or not these factors are impacting certain socioeconomic or racial/ethnic groups disparately.