Description: Gene therapy is a quickly evolving field and will continue to grow as a risk concern for many health plans, stop loss insurers and reinsurers. Currently, there are only two approved gene therapies in the U.S., but that number is expected to escalate starting in the fall of 2022. Revisit the experience plans have had with the first two gene therapies, discuss plan design and network considerations in light of gene therapy, and discuss the actual composition of the near-term pipeline along with a range of modeled financial impacts and considerations for payers.

Description: The Casualty Actuarial Society (CAS), the Society of Actuaries (SOA) and the Society of Insurance Research (SIR) started developing research addressing diversity, equity and inclusion (DEI) topics. Join panelists as they briefly present an overview of their organization's DEI research and share their perspectives on common challenges facing all the stages of this research: - Planning relevant and timely research with a long timeline. - Getting appropriate data and resources to support your research. - Communicating research on topics that may be controversial.

Description: Are you interested in learning about technical changes to the risk adjustment methodology, Texas implementing effective rate review and premium alignment rules, new rules on standard benefits and network adequacy? Discover some of the reasons why the 2023 ACA marketplace will look much different in the first year of the Biden administration setting the tone with annual ACA rules. Listen to a panel of consulting actuaries and the Chief Actuary from the Texas Department of Insurance who are deeply involved in state and federal policy, risk adjustment methodology, and continuous monitoring of changing market dynamics. Explore new federal rules, efforts to strengthen enforcement of rating compliance, current considerations in risk adjustment methodology, and the ACA market outlook for 2023 and 2024.

Description: Risk Adjustment continues to be a hot topic in Health Insurance since its emergence. This mechanism came into being as a means of reducing the risk of selection, particularly in marketplaces where underwriting is not allowed, and rating factors are significantly restricted. Risk adjustment serves to adjust premiums to reflect the risk of individual members or overall members as a whole within a particular cohort of a health plan. Risk adjustment is not perfect, as it does not perfectly predict future costs or perfectly adjust for the differences in expected costs. Different marketplaces have different challenges with risk adjustment.

Description: This is a Request for Proposals (RFP) issued by the SOA Research Institute (SOARI) seeking research studies related to anxiety, depression, and their impact on mortality in the United States.

Description: This report is targeted to actuaries that are interested in identifying the adverse human health outcomes resulting from anthropogenic climate change. This is accomplished by providing a detailed framework to evaluate the impact of extreme heat on human health and identify the role that anthropogenic climate change has on extreme heat events. Although this document is designed around extreme heat, the concepts can be expanded to other climate-related events. As the primary focus of actuarial research is to promote human health and minimize the preventable economic burden, this document also provides recommendations to mitigate against excess heat related illness (HRI) due to extreme heat.

Description: A divisive confrontation over health care pricing is almost inevitable over the next few years. What will ultimately happen is a political decision, not an actuarial one—but it will have major consequences for the trend in health care costs and the divergence between public and private insurance premiums.

Description: In 2018, the Financial Accounting Standards Board (FASB) adopted significant revisions to the U.S. GAAP insurance accounting literature, via Accounting Standards Update (ASU) 2018-12. The title of ASU 2018-12 is “Targeted Improvements to the Accounting for Long-Duration Contracts,” and as a result, a common acronym for ASU 2018-12 is LDTI (long-duration targeted improvements).

Description: PBMs are positioned in the healthcare delivery system as the only entity that is not regulated for profitability. The Commercial Fully Insured Health Insurance Plans are heavily regulated by the State Insurance Commissioner who allows only 2%-3% profit margin. The self-funded Health Plans are regulated by ERISA fiduciary responsibility that prohibits excessive compensation. PBMs are classed as a service provider and are not regulated by either. This allows PBMs to implement large, unreasonable mark ups for profit. PBMs are massive commercial entities, states are trying to sue under antitrust law. PBMs found a sweet spot in the regulation. Large Insurance Carries understood that and either acquired large PBMs or merged with them. It is likely that a combination of measures will be needed to regulate PBMs. The most direct approach would be for Congress to pass a law establishing PBM as a fiduciary under ERISA just like an “investment advisor” providing advice for a fee. Establishing PBM as a fiduciary will help Courts and other Federal Agencies ensure that PBMs do not unfairly retain rebates and inflate the prices of Rx drugs sold to employer health plans, and the US population in general.

Description: Discussion of recent developments in the taxation of noncoordinated benefits such as fixed indemnity, hospital indemnity, and specified disease insurance policies. Developments include a recent Chief Counsel Advice Memorandum and proposed triagency rulemaking that would impact non coordinated benefits.