Description: The supplemental health market is changing. Carriers are looking to simplify claims processes, proactively identify missed claim opportunities, and reduce barriers to claim payment. As a result, more and more companies are looking at ways to use data from medical diagnostic and treatment codes. Take an introductory look at the most used medical codes—ICD (9 and 10), CPT, and HCPCS. Discuss the history and purpose of each code system and decipher the structure. Dive into how medical codes can be used in the supplemental health market (automatic claims adjudication, fraud identification, pricing), as well as common pitfalls encountered when using medical coding. By attending this session, you will have a basic understanding of the different types of medical codes, their actuarial applications, and common pitfalls.

Description: Review recent incidence trends based on incidence data from 2005 to 2015. Examine proposed modifiers with IDIVT 2013 incidence tables and its impact on active life reserves. By attending this session, you will be able to: • Understand how your company experience compares vs. Industry. • Identify potential LDTI impacts based on industry experience. • Develop incidence modifiers for pricing and projections based on industry experience.

Description: The rules governing the framework of Affordable Care Act (ACA) marketplaces continue to be refined at the state and federal level. The catalyst for such changes has been a desire to improve markets, which has been primarily informed by data and experience in the ACA's first decade. This session will feature a panel of consulting actuaries, a state policy advisor who has influenced ACA legislation, and an attorney deeply involved in ACA risk adjustment litigation. Discussion will include new federal proposals, efforts to strengthen enforcement of rating compliance, new actuarial insights from public data, and the anticipated future implications for ACA markets. By attending this session, you will be able to: • Understand what precipitated risk adjustment lawsuits and how proposed federal rules address these concerns. • Identify how state regulators are addressing premium misalignment between metal levels and shaping local policies. • Develop new insights on publicly available data. • Understand the implications these policy changes will have on the future of pricing health insurance benefits, consumer value and enrollment distributions in ACA marketplaces. • Understand the primary factors leading to ACA market success.

Description: The Actuarial Research Clearing House (ARCH) is an informal communication providing current actuarial research to friends and members of the actuarial community. View the second issue for 2024.

Description: In the game of chess, both players have perfect knowledge of the board. In poker, however, players deal with asymmetric information as well as the fact that your opponent can lie. There is an old expression that smart people are “playing chess when their opponents are playing checkers.” However, playing chess when your opponent is playing poker is a recipe for disaster (for the chess player, that is). Parameter risk is more akin to poker than chess, and it is often overlooked in favor of volatility risk in stop loss and reinsurance pricing. Unlike volatility risk, however, parameter risk does not necessarily decrease as the group size increases. Understanding the impact of parameter risk can help avoid mispricing the risk at hand as well as the impulse to provide false precision. False precision can lead to poor underwriting decisions and financial losses. In this session, the presenters will provide examples of parameter risk as well as potential solutions to incorporate when building simulation models. By attending this session you will be able to recognize potential areas of parameter risk and understand techniques to incorporate parameter risk in simulation modeling.

Description: Currently there are ten states in the U.S. —Rhode Island, California, New Jersey, New York, Washington, DC; Washington, Massachusetts, Connecticut, Oregon and Colorado —that have enacted Paid Family Leave. Paid Family leave is an employee funded state insurance program that provides wage replacement to eligible workers when they take time off of work to care for a seriously ill family member or to bond with a new child. Who pays the taxes? The employer or the employee? How will this effect short term disability benefit offerings in the work place? How does a Paid Family Leave plan get implemented? Is it up to the employee to file for the benefit through the unemployment office or does the employer file? At the state level, how is paid family leave reserved for? How is it administered? What job protections are there? How does this work with the Family Medical Leave Act? Get these and more questions answered. By attending this session, you should have an understanding of the state Paid Family Leave programs, what it means to future short term disability plans, and how the state accounts for this program.

Description: Dive into the challenges of practitioners working across components that make up the Risk Management infrastructure with a variety of health, life and P&C insurers in this panel discussion webcast. Panelists will highlight how these insurers operate with the data and tools available to them and the existing challenges in interactions with an organization's leadership. Be part of this webcast that delves into the interplay between first- and second-line defense and how high levels of independence and professionalism can be achieved in a fast-moving, multi-discipline cross functional ERM role.

Description: Internal audit (IA) projects typically focus on evaluating the risks and operational effectiveness of a company’s technological, regulatory/compliance, and/or financial processes and procedures. Because LDTI and IFRS 17 compliance will require extensive rewiring of existing and possibly the implementation of new processes and procedures to comply with the new accounting requirements, IA will be critical in conducting the initial risk assessment of these changes, monitoring of the process changeover, and conducting a post-implementation validation after conversion. Explore many specific areas that will be impacted, highlight those aspects likely to be under the IA magnifying glass, and find out how you can best prepare your IA teams to understand the changes and expedite the testing timeframes of their audits. By attending the session, you will be able to: • Understand general IA testing approach and framework. • Identify and address the key processes and procedures likely to be impacted by accounting change. • Build a communication plan that tailors the level of detail of documentation to the intended audience. (e.g., Leadership and BOD) • Document decisions made and implemented with IA in mind.

Description: CMS has pioneered innovative strategies for Medicare and Medicaid to address Social Determinants of Health (SDOH). Employers can learn from these models to implement similar approaches for their employee populations. Learn how employers can understand and address SDOH, the incentives for doing so, and the broader benefits.

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.