Description: In 2007 the International Accounting Standards Board IASB released a discussion paper proposing a new accounting model for insurance contracts, known as the current exit value model. One aspect of the proposed accounting model is that claim liabilities would need to include explicit margins satisfying certain criteria. Currently it is common for U.S. medical insurers to include explicit margins in their claim liabilities. However, we demonstrate that the margin approach most commonly used today by U.S. medical insurers does not satisfy the objectives articulated in the IASB discussion paper regarding the role of margins. We then propose a new formula for including explicit margins in U.S. medical insurance claim liabilities in a manner that is more compatible with the principles articulated in the IASB discussion paper. Finally, we illustrate our proposed claim liability formula using an example drawn from real-life data.

Description: This article contains excerpts from the first three articles that were released through the strategic initiative - Commercial Health Care: What’s Next?

Description: Provides a summary of recent proposed regulations for the health insurer fee, section 9010 of the Affordable Care Act (ACA).

Description: Using Healthcare Claims Data to Create Actuarial Models.

Description: Essay states a competing American ideals for the U.S. Health care system include free markets which foster competition, cost effectiveness and quality health care vs.public and private assistance which provides health care independent of a person’s financial means.

Description: This article makes organizations entering the MA market aware of the star rating climate, as well as short- and long-term star rating & revenue considerations.

Description: The PPACA imposed a market share-based health insurance provider fee, known as the "Section 9010 Fee", "Health Insurer Fee", or simply the "HIF", on each “covered entity” with net premiums written in excess of $25 million that is engaged in the business of providing health insurance coverage for U.S. health risks. This article provides background information to help unpack the language behind the Section 9010 Fee and highlights a few areas of special interest including merger and acquisition-related issues, application of the Section 9010 fee to expatriate plans, and considerations regarding fee administration.

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

Description: Recap of Q&A sessions held to discuss the findings and methodology of a SOA study on the cost of the newly insured under the ACA.