Description: This article is an update on the No Surprises Act, which is a U.S. Act aimed to reduce the risk that a person unexpectedly receives out of network charges for their health care visits.

Description: Through the sponsorship of the Robert Wood Johnson Foundation, The Society of Actuaries partnered with Wakely to use their health care data to study the effects of COVID-19 on overall health care claims for individuals with a COVID-19 diagnosis. The conclusion of the study is that individuals with COVID-19 claims had significant increases in health care costs leading up to their months of diagnosis, as well as in the months following their diagnosis. These effects were more pronounced for individuals who were hospitalized due to COVID-19 as well as for individuals with prior co-morbidities. Finally, the overall health care costs of these members plateaued at significantly higher levels than their pre-COVID baselines. In fact, all the main membership cohorts experienced claim levels that were at least 20% higher than their pre-COVID starting points.

Description: This research report provides an evaluation and synthesis of the methodologies and data samples used on characterizing health care fraud.

Description: Yi-Ling Lin, FSA, MAAA, FCA, started the SOA’s Predictive Analytics Certificate Program to keep pace with the impact big data and predictive modeling is having on the health care industry

Description: A follow-up to the 2012 article “A Global Perspective of the Health Insurance Market” about teaching a course at the Columbia University Masters in Actuarial Science program. The course provided an overview of the health care insurance industry.

Description: This paper examines the factors affecting claims in a group health insurance plan.

Description: In the last 10 to 15 years, new health insurance programs have proliferated in the Latin American and Caribbean regions. The reason for this boom has been, basically, the need for insurance companies to identify and implement new or additional lines of insurance business in order to match or exceed the increased numbers of competitors now working in these markets. This is combined with the stronger reinsurance capacity that these insurance companies had access to, which can be attributed to the need for increased reinsurance protection that arose a number of years ago, when many insurance and reinsurance companies were seeking larger volumes of businesses based on the expected growth potential of the region.

Description: Key Health Issues for 2003, as identified by the Health Benefit Systems Practice Advancement Committee HBSPAC and the Health Section Council HSC of the Society of Actuaries, which will have their top priority attention.

Description: Milliman performed an analysis of 894 uses of the checking service on individual medical health insurance applications to gain a better understanding of its protective value. From Health Watch Newsletter, September 2006, Issue No. 53.