Description: The SOA’s research objective is to provide guidance to state exchange officials and administrators, federal officials and administrators, and actuaries assisting states and health plans. The goal of the project is to estimate the morbidity and/or cost for newly insured individuals in the individual market (and to some degree, the small group exchange) relative to the morbidity and/or cost for the current commercially insured population. This analysis will primarily focus on the individual, non-group market. In order to plan for the impact that these currently uninsured individuals will have on the health insurance markets, it will be important to understand their costs relative to the costs for people already enrolled, for whom many health insurers have experience and data.

Description: This article outlines and summarizes research from Swiss Re about the prevalence of the Health Protection Gap throughout Asia, with a particular focus on China. Authors Robert Burr and David Zhang share key statistics on the scope of the gap, which is more than 800Bn USD in China alone, and discuss the role that technology and private-public partnership can play in reducing this gap over time. Readers will come away with an understanding of the scale of the problem within the Asia region as well as new ideas on how to solve similar problems within their own region.

Description: In the last 10 to 15 years, new health insurance programs have proliferated in the Latin American and Caribbean regions. The reason for this boom has been, basically, the need for insurance companies to identify and implement new or additional lines of insurance business in order to match or exceed the increased numbers of competitors now working in these markets. This is combined with the stronger reinsurance capacity that these insurance companies had access to, which can be attributed to the need for increased reinsurance protection that arose a number of years ago, when many insurance and reinsurance companies were seeking larger volumes of businesses based on the expected growth potential of the region.

Description: NAIC Health Update from quarterly meeting. Issue No. 42.

Description: The coming wave of biosimilars could dramatically affect prescription drug costs and benefit strategies over the next several years. The launch of many Humira biosimilars in 2023 is the Big Event that will largely determine the impact of the biosimilar wave. Payers have many decisions to make about coverage and formulary tiers. What factors will drive payer decision-making?

Description: A research report describing aspects of provider network performance in health care settings with particular focus on experiences with Exchanges.

Description: A research report that first defines ERM and provides the results of an applicable literature search with hyperlinks and then describes the current state of Enterprise Risk Management practices for health organizations. Areas covered: 1. Operational Risks. 2. Balance sheet risks. 3. Pricing discipline. 4. Asset risks. 5. Learnings. 6. Emerging risks.

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

Description: Authors demonstrate the use of the claim reserve run-out test for the long-term A&H products. They present the method of this test and show a numerical illustration to depict interpretations of testing results.

Description: A discussion of outrageous, criminal and soft fraud in health insurance.