Description: The process of setting initial and renewal premium rates for small group medical block of business using risk characteristics. Presents three pricing schemes and compares profitability Following the Curve, Lowest Best Rate and Highest Worst Rate.

Description: Using data to develop reserves for Incurred Prior Paid After and Incurred but Unpaid, Issue No. 38

Description: Actuarial appraisal and role of the actuary with regards to Health Insurance Mergers and Acquisitions. Issue No. 40.

Description: Hospitals, through consolidation and affiliations, gaining back negotiation strenght lost due to managed care in the 80s and 90s. Charges vary significantly by area and facility. Issue No. 46.

Description: This article discusses the advantages, logistical concerns, and pricing formulas of implementing a TNHP, in which members pay less for treatment from providers who meet higher quality and cost-effectiveness standards.

Description: When setting reserves, multiple methods are often used in the creation of the reserve estimate. Judgment is warranted to combine these different estimates into a final recommendation. This paper describes two techniques that can be used to combine these estimates that may result in better accuracy and lower variance.

Description: This article contains a condensed summary and excerpts from a recent white paper regarding the Individual Mandate.

Description: A discussion of an alternative valuation methodology which addresses many of the shortcomings of the current valuation system for U.S. life and health insurers one of which is the proliferation of undesirable variations in state requirements. Issue No. 37

Description: This article reviews the cost of behavioral health care and looks at how the involvement of Primary Care Physicians leads to a less efficient and effective treatment and is an increasing cost many plans have yet to address. From Health Section Newsletter, March 2005, Issue No. 49.

Description: This article looks at pharmacy benefit management and the use of data, reviews standard pharmacoeconomic analysis methods, and discusses points for formulary decision making and what is known about the process. From Health Section News, March 2005, Issue No. 49.