Description: Cost is a key outcome metric used by actuaries and others to determine the value of a benefit or program in health insurance. However, typically, costs assessed include only the direct costs of the program, not any indirect costs or savings, such as those associated with reduced spending on other services.

Description: After 10 years, the Affordable Care Act (ACA) risk adjustment program has evolved as the ACA has evolved. In recent years the Centers for Medicare and Medicaid Services (CMS) has focused attention on predictive accuracy over compensating for actuarial risk and has failed to address systemic issues such as insolvencies that created suboptimal outcomes for the ACA markets.

Description: The Tri-Agency published the final rule on short-term limited duration insurance and fixed indemnity coverage at the beginning of April. We’ll break down the new rule, approaches to complying with the new requirements, and what implications it could have for the supplemental health market moving forward.

Description: This session will focus on the latest regulatory changes impacting commercial dental plans, including recent developments in Minimum Loss Ratio Requirements (MLR) and the potential inclusion of adult dental services as an Essential Health Benefit (EHB).

Description: This webcast will update listeners on the financial status of the U.S. Social Security program, describe half a dozen widespread myths, and discuss the reality of "waste, fraud and abuse" in the program.

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: This newsletter provides a regulation outlook for the use of AI/ML in insurance industry, interpretations of regulatory expectations and what insurers should consider when managing risks associated with the development, implementation and use of AI/ML models/tools.

Description: Stakeholders in a specific state (Minnesota) were interviewed about the potential value -- and obstacles -- of a catastrophic backstop program to handle long term care (LTC) financing needs. The design would entail a payroll deduction which would produce a fund to pay LTC expenses once a deductible period (of 1 to 4 years, depending on income) was reached. This design was believed to encourage enrollees to cover the front end better than done today, whether by private insurance or other means.

Description: Review of paper describing Collective Defined Contribution Plans. the elimination of traditional pensions by many companies have left employees without easy access to reliable retirement income Collective Defined Contribution plans which are used to a small extent in the US but more broadly used elsewhere offer an option for consideration.

Description: Description of US Social Security COLA effective December 2024 and other automatic adjustments effective for 2025