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This paper focuses on one relatively narrow area of rules that is sometimes loosely referred to as actuarial compliance, and serves as a primer for actuaries or other professionals who are tasked with understanding and following these rules.

Health and group benefits news and developments in the United States.

Health and group benefits news and developments in the United States.

This paper explores what price transparency means in the healthcare market, the forces driving the need for price transparency, challenges and uses of price transparency, and potential ways in which transparency can be improved for the benefit of consumers and also to be more effective in reducing overall healthcare costs.

This paper discusses risk-adjusted allowed costs in the context of large self-insured employers that are looking to identify efficient providers and directly contract with them to reduce costs and/or improve employee health outcomes.

The difference between prospective payments from Centers for Medicare and Medicaid Services and actual cost-sharing reduction payments may have a significant impact on quarterly financial statements for some carriers.

Actuaries need to consider the combined impact of the risk adjustment program, the transitional reinsurance program, and risk corridors on a company’s balance sheet.

What strategies can CO-OPs use to become financially viable by increasing market share and scale?