Description: Discussion topics include analysis of actual-to-expected loss experience, tracking of pricing adequacy and competitiveness, leading indicators of financial results, profitability measurement and source of earnings analysis and similarities/differences in individual and group financial management. From the Record of the Society of Actuaries, Volume 29, No. 3, Session 36

Description: Panelists discuss current issues and trends impacting health plan contracting with providers. Hospital and physician contracting is discussed from both a payer's and provider's persepctive. From the Record of the Society of Actuaries, Volume 30, No. 1, Session 30

Description: This session summarizes recent trends in behavioral health parity, pros and cons of parity, the impact of mandated benefits on near-term medical costs and methods to effectively manage mental health utilization. From Record of Society of Actuaries, Vol. 30, No. 1, Session 81

Description: This paper presents a method involving re-sampling 'with replacement but without random numbers', numerical convolutions for sums and quotients, and estimation of confidence intervals for trend in average size claim. In this paper, this method is applied to major medical claims.

Description: In 1983, a poultry virus hit the jackpot in Pennsylvania. While making a copy of its genetic material, the virus made a tiny error. Because of that error, it began producing a slightly altered protein which allowed the normally benign organism to spread beyond its usual residence in chicken lungs and intestines. Soon it was burrowing into other parts of the birds’ bodies - including the nervous system, where it multiplied rapidly and began to cause disease. Could something like this happen to humans?

Description: This report provides morbidity experience under Individual Loss-of-Time policies, 1974-1975.

Description: Learn about key actuarial and analytic tools and methodologies used by commercial health insurance to identify and quantify drivers of healthcare cost and utilization (including wasteful and low-value ones) and risks. Use case scenarios in which these tools and methodologies apply, such as underwriting, reinsurance, medical management for population health and chronic diseases, managed care contracting, insurance market reform, provider payment reform, etc., will also be covered. Experience from the U.S., China and other parts of the world will be shared.

Description: After the bid process, desk review, rebate reallocation, an “enjoyable” audit, and open enrollment; the Medicare plan year starts. Throughout the year, organizations find it pertinent to get an accurate picture of their Part D liability as reinsurance, LICS (Low Income Cost-Sharing) subsidy, and risk corridors are accrued. Attendees will learn about the basics of Part D accruals, how future accrual amounts are estimated based on patterns in the data, and how bid assumptions versus actual results impact plan sponsor profitability. We will also discuss financial statement treatment of these items. Real-life examples from bids to outcomes will be provided to enhance the discussion. Ultimately, attendees will come away with a deeper understanding how their bid assumptions play out, and how they can use Part D accruals to plan for future bid development.

Description: This session from the 1994 Valuation Actuary Symposium focuses on long-term projections of health insurance, the uses of the projections, the type of model to use and model considerations for the projections.

Description: Presented at September 1994 Valuation Actuary Symposium. Discusses analyzing and projecting financial risk in group health plans.