Description: Pricing Small Group Medical Coverage Renewal Pricing regression to the mean, blending of experience and manual rates, small group reform laws. Issue No. 40.

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. This is Part 2; Part 1 was featured in Health Watch's Sept 2024 issue.

Description: The Health Section Research Team is pleased to make available the following research study and Excel model that provide a framework for estimating the financial impact of health plan provider network risk. The research was conducted by the Denver office of Milliman, Inc. The Excel workbook allows the user to assess cost implications of aspects of network risk under various assumptions. The assumptions in the workbook can be altered by the user and be applied to test a range of scenarios.

Description: Describes a process to develop a good forecast. Also provides an example.

Description: The presenters will provide insights into fraud and abuse risk in the health insurance industry, including an examination of traditional and predictive modeling techniques for both prevention and detection. Emphasis will be placed on current and emerging risks. Canadian examples and perspectives will be offered, but the applications for attendees to use in practice are non-nation specific.

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: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

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.

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