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: In this video led by Mitchell Momanyi, FSA, MAAA, the types of Medicare products available is discussed. This two major types are traditional Medicare and Medicare Advantage. It discusses how traditional Medicare encompasses Parts A and B, covering various inpatient and outpatient services but not long-term care or prescription drugs, which fall under Part D. The video details deductibles, cost-sharing structures, and options like Medigap plans that assist with Traditional Medicare’s out-of-pocket expenses. Mitchell emphasizes clarity and understanding while sharing his expertise in this comprehensive overview.

Description: Kevin Pierce, FSA MAAA divesinto the Inflation Reduction Act’s impact on US drug pricing. He discusses two key provisions: Inflation rebates, where pharmaceutical manufacturers must pay rebates to the government if drug prices rise faster than inflation, and drug price negotiation by Medicare, set to commence in 2026 for selected drugs. Contributors: Kevin Pierce, FSA, MAAA, Deana Bell, FSA, MAAA Mitchell Momanyi, FSA, MAAA, Jon Forster, ASA, MAAA

Description: Fifty-three percent of Americans responding to a survey conducted by the Society of Actuaries (SOA) Research Institute reported that extreme weather events – including hurricanes, tornadoes, heatwaves, wildfires and flooding – have adversely affected their health.

Description: The proposed session will introduce Outcome Based Risk Sharing Arrangements (“OBRSA”) between health insurance payers (“payers”, including insurance companies, health plans, sponsored employers, and government programs) and pharmaceutical manufacturers (“pharma”), and it’s intended to meet the needs of actuaries who focus on pharmacy benefits and risk sharing arrangements. The covered content will include (1) the background of OBRSAs, definitions, stakeholders, and OBRSA’s role in shifting the system from volume-based toward value-based; (2) conflicting perspectives about OBRSAs between payers and pharma (cultural and methodological); (3) identification of incentive gaps between payers and pharma, and incentive alignment between them; (4) barriers to implement OBRSAs; (5) limitations and considerations of OBRSA implementation; and (5) hypothetic OBRSA examples.

Description: Letter from the Editor

Description: Read the March 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Description of and reasons for Health Section strategic initiative relating to self insurance

Description: The CMS Risk adjustment model allows actuaries to apply our analytical skills and business knowledge to solve risk and revenue challenges within Health Plans.

Description: Collaborative filtering models drive recommendations provided by Netflix and Amazon. This article uses the same models to explore patients’ medical conditions.