Description: Chapter 2 analyzes, in table form, the study's claimant counts and charge totals, broken down by gender, age, diagnosis category, year, and by subscriber vs. dependent status. From Group Medical Insurance Large Claims Database Collection and Analysis, M-HB97-1.

Description: "This video by Danika Turner is an introduction to Medicare Advantage revenue, specifically focusing on how Part C revenue works for individual Medicare Advantage plans. It explains how health plans participating in the Medicare Advantage program are paid by the Centers for Medicare and Medicaid Services (CMS), including the impact of Star ratings, risk adjustment, and county-level CMS benchmark rates on revenue. The session aims to simplify the main variables of the revenue calculation and uses conceptual examples for individual MA plans, excluding certain populations like Employer Group Waiver Plans and members with End-Stage Renal Disease or in hospice. The video also covers the basics of Medicare-covered services, mandatory and optional supplemental benefits, and the calculation steps for determining CMS Part C revenue per member per month.

Description: In an effort to build a bridge between epidemiological and actuarial modeling, this paper analyzes possible financial arrangements made against expenses resulted from medical treatments given to insured patients. Based on classical compartment models, the first part of this paper designs insurance policies for susceptible participants facing the risk of infection and formulates the financial obligations of both parties using actuarial methodology. For practical purposes, the second part employs a variety of numerical methods for calculating premiums and reserves. The last part illustrates the methods by designing insurance products for the Great Plague in Eyam and the SARS Epidemic in Hong Kong.

Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: Summary and analysis of the diseases and conditions exhibited in the Medicare Advantage population

Description: Health Watch, Issue 79, December 2015, Health Watch

Description: This article is focused on sustainability concerns in the ACA individual markets and what we can learn from core actuarial principles as discussed in ASOPs.

Description: A physician discusses white matter lesions on the brain - their nature, causes, severity, importance, associated risks, and underwriting implications for long term care insurance.

Description: Table from an article in The Actuary Magazine on an analysis of risk management terminology: your guide to speaking ERM with different industries. Volume 4, Issue 6

Description: Chapter 6 identifies four general and practical considerations in comparing methods: practicality and administrative cost, ability to restrict manipulation, timeliness and predictability, and incentives for efficiency and quality care. From A Comparative Analysis of Methods of Health Risk Assessment, M-HB96-1.