Description: This Fellowship credit research paper describes the use of fuzzy sets applications to the selection of group health risks. In general, fuzzy set theory is implemented to describe collections of objects whose boundaries are not precisely defined, as in the judgment of what constitutes a good risk group. First, single-plan underwriting is considered, then the work is extended to multiple-option plans.

Description: 1973 SOA Regional Meetings, Saint Paul and San Francisco. This paper provided a summary of several concurrent sessions from the referenced meetings including: 1. PRICE DISCLOSURE AND COST COMPARISON. 2. INDIVIDUAL LIFE AND HEALTH UNDERWRITING. 3. TIME SERIES ANALYSIS AND FORECASTING. 4. INDIVIDUAL HEALTH INSURANCE - PROBLEMS AND PRODUCT TRENDS. 3. VARIABLE LIFE INSURANCE. 6. POLLUTION, POPULATION, AND THE QUALITY OF LIFE. 7. HEALTH MAINTENANCE ORGANIZATIONS.

Description: The Health Section Research Team is pleased to make available the following research study and Excel model that provide a framework for estimating the financial impact of health plan provider network risk. The research was conducted by the Denver office of Milliman, Inc. The Excel workbook allows the user to assess cost implications of aspects of network risk under various assumptions. The assumptions in the workbook can be altered by the user and be applied to test a range of scenarios.

Description: This paper suggests that using the entire runoff triangle to keep a tail on the runoff curve was not necessary, and that doing so was actually a disadvantage if group medical and dental claim payment patterns changed over the period being used. An alternative was presented. From Actuarial Research Clearing House 1993, VOL. 3.

Description: This 1993 paper examined the premium rate changes that could have resulted from the passage of The Health Insurance Reform and Cost Control Act of 1991. From Actuarial Research Clearing House 1993, VOL. 3.

Description: This is an internal letter from an actuary to an associate regarding a claims study that established, in the mind of the writer, the adequacy and conclusiveness of a small sample size in certain situations. Actuarial Research Clearing House ARCH 1988, Vol. 3

Description: This paper develops a parametric model for health care insurance claims to fit parametric models to the data. Model selection is based on the ChJ-squared goodness-of-fit test and a comparison of the empirical limited expected value function to parametric limited expected value functions. A copula function was used to model the bivariate portion of the data. From Actuarial Research Clearing House 1993, VOL. 3.

Description: This paper describes a process for developing rates for a preferred provider organization [PPO]. From Transactions of Society of Actuaries 1985, Vol. 37.

Description: In this paper, a model is proposed as a potential explanation for the steady deterioration in loss ratios often observed on blocks of individual health insurance policies. This model, which incorporates assumptions of anti-selective lapses, can be used for morbidity projections and projections of the effects of rate increases. Discussions of this paper are included.

Description: This paper discusses the purpose and nature of the benefit ratio [otherwise known as active life] reserve in relation to the class of health insurance contracts to which it is intended to apply. From Transactions of Society of Actuaries 1988, Vol. 40, Pt. 1.