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

Description: This is a discussion of the medical loss ratio, the confusion and debate over the calculation method under the new MLR requirement, and the opportunities it presents to consulting actuaries.

Description: The SOA’s research objective is to provide guidance to state exchange officials and administrators, federal officials and administrators, and actuaries assisting states and health plans. The goal of the project is to estimate the morbidity and/or cost for newly insured individuals in the individual market (and to some degree, the small group exchange) relative to the morbidity and/or cost for the current commercially insured population. This analysis will primarily focus on the individual, non-group market. In order to plan for the impact that these currently uninsured individuals will have on the health insurance markets, it will be important to understand their costs relative to the costs for people already enrolled, for whom many health insurers have experience and data.

Description: A call for essays issued by the SOA Health and Long Term Care Sections on the visions for the future of the U.S. health care system.

Description: The coming wave of biosimilars could dramatically affect prescription drug costs and benefit strategies over the next several years. The launch of many Humira biosimilars in 2023 is the Big Event that will largely determine the impact of the biosimilar wave. Payers have many decisions to make about coverage and formulary tiers. What factors will drive payer decision-making?

Description: This article discusses the potential characteristics of health care reform and the associated impact on small insurance companies.

Description: Authors demonstrate the use of the claim reserve run-out test for the long-term A&H products. They present the method of this test and show a numerical illustration to depict interpretations of testing results.

Description: From a session at the Health/Pension Spring Meeting held in New Orleans, Louisiana June 15-17, 2005 Panelists discussed some of the research behind understanding decision-making and how this type of research can be used to enhance the modeling of consumer choice. Discussion of the field of behavioral economics and its potential application in improving assumptions for modeling health care purchasing.

Description: This session is targeted for new ASAs/FSAs or actuaries who are new to reserving. The session will be delivered in two parts. The first part is intended to deliver a basic understanding of IBNR reserving and different reserving methods and assumptions. We will go through examples of constructing claims triangles and developing completion factors, while exploring concepts such as seasonality, trend and outlier claims. During the second part of the session, we will apply the material from the first part to look at various example from different products such as inpatient, outpatient, RX, Medicare Supplement, dental, critical illness, etc.

Description: Update on Affordable Care Act topics, including Section 1332 waivers, Association Health Plans, silver loading and cost sharing reductions.