Actuarial Notes

Exam GH-101

GH 101 – Benefits and Pricing is an exam of the Society of Actuaries' Fellowship (FSA) pathway. Its syllabus covers the Nov 2026/Mar 2027/Jul 2027 sittings.

Learning Objectives

Plan and Product Provisions (10–20%) The candidate will understand how to describe plan provisions typically offered under short duration contracts (medical, dental, vision, prescription drug, group life).

  1. Describe typical organizations offering these contracts
  2. Describe each of the contracts listed above
  3. Evaluate the potential moral hazard and financial and legal risks associated with each type of contract
  4. Describe the product development process including risks and opportunities to be considered during the process

Readings:

  • Video: The Variety of Short-Term Health and Group Benefits (Background)
  • Video: Plan Sponsor Perspective (Background)
  • Video: Actuarial Roles in Health (Background)
  • Group Insurance, Skwire, Daniel D., 8th Edition, 2021
    • Ch. 3: Product Development (1d)
    • Ch. 5: Medical Benefits in the United States (1a, 1b, 1c)
    • Ch. 6: Dental Benefits in the United States (1a, 1b, 1c)
    • Ch. 7: Pharmacy Benefits in the United States (1a, 1b)
    • Ch. 11: Group Life Insurance Benefits (1a, 1b, 1c)

Manual Rates (25–40%) The candidate will understand how to calculate and recommend a manual rate for each of the contracts described in Learning Objective 1.

  1. Identify and evaluate sources of data needed for pricing, including the quality, appropriateness, and limitations of each data source
  2. Develop a medical cost trend experience analysis
  3. Calculate and recommend assumptions
  4. Calculate and recommend a manual rate (includes developing a base rate and applying a rating manual)
  5. Identify critical metrics to evaluate actual vs. expected results
  6. Apply actuarial best practices in evaluating and projecting claim data

Readings:

  • Group Insurance, Skwire, Daniel D., 8th Edition, 2021
    • Ch. 20: Pricing of Group Insurance (2a, 2c)
    • Ch. 21: Estimating Medical Claim Costs (exclude Appendix: Data Sources) (2a, 2d)
    • Ch. 22: Estimating Dental Claim Costs (2a, 2c, 2d)
    • Ch. 23: Estimating Pharmacy Claim Costs (2a, 2c, 2d)
    • Ch. 35: Medical Claim Cost Trend Analysis (2a, 2b, 2c)
  • GH101-100-26: Chapter 5 of Individual Health Insurance, Leida, Hans, 3rd Edition, 2026 (2b, 2c, 2d)
  • Group Insurance, Skwire, Daniel D., 8th Edition, 2021 (2a, 2c- 2e)
    • Ch. 24: Estimating Life Claim Costs
  • Closing the Analytical Loop: Technology Assessments and Actuarial Methods, SOA Research Institute, Jan 2025 (2c)
  • ASOP 12: Risk Classification (excluding Appendices) (2f)
  • ASOP 23: Data Quality (excluding Appendices) (2f)
  • ASOP 25: Credibility Procedures (excluding Appendices) (2f)
  • ASOP 41: Actuarial Communications (excluding Appendices) (2f)

Underwriting and Funding (25–40%) The candidate will understand how to apply principles of pricing, risk assessment, and funding to an underwriting situation.

  1. Understand the risks and opportunities associated with a given contract, eligibility requirement, or funding mechanism
  2. Understand, evaluate, and apply risk assessment mechanisms
  3. Recommend strategies for appropriately pricing, underwriting, and funding case-specific risks
  4. Describe and apply approaches to claim credibility and pooling
  5. Apply Total Risk Analysis (TRA) strategies to case-specific pricing

Readings:

  • Group Insurance, Skwire, Daniel D., 8th Edition, 2021 (3d)
    • Ch. 26: Experience Rating and Funding Methods
  • GH101-102-25: Types of COB and Impact on Medical Claim Data (3a)
  • GH101-101-25: Illustrative Examples on Experience Rating and Funding Methods (3a, 3c)
  • The Role of the Actuary in Self-Insurance, May 2018, Sections 4, 5 & Appendices (excluding 4.1.1-4.1.5, 4.4, 4.6.1-4.6.3 & Appendix D) (3a, 3d)
  • Level Funding: An Alternative to ACA for Small Groups, Health Watch, May 2016 (3a)
  • Group Insurance, Skwire, Daniel D., 8th Edition, 2021
    • Ch. 29: Group Insurance Underwriting (3a)
    • Ch. 30: Managing Selection in a Multiple-Choice Environment (3c)
  • Modeling Effects of Enrollee Choice, SOA, Jan 2021 (3c)
  • Group Insurance, Skwire, Daniel D., 8th Edition, 2021 (3b)
    • Ch. 34: Health Risk Adjustment (pp. 579-585)
  • Calculated Risk: Driving Decisions Using the 5/50 Research, SOA Research, Jan 2025, Sections 1 (background only), 2 & 3 (3e)
    • Excel Model: Calculated Risk

Employee Benefits (15–25%) The candidate will understand how to evaluate and recommend an employee benefit strategy.

  1. Describe the structure of employee benefit plans and products offered, and the rationale for offering these structures
  2. Recommend an employee benefit strategy in light of an employer’s objectives

Readings:

  • GH101-103-25: Health Plan Payroll Contribution Strategies and Development for Employers (4b)
  • GH101-106-25: Ch. 2 & Ch. 24 of The Handbook of Employee Benefits, Rosenbloom, 7th Edition, 2011 (4a)
  • GH101-104-25: Recommend an Employee Benefits Strategy (4b)
  • Consumers to the Rescue? A Primer on HDHPs and HSAs, Health Watch, Feb 2019 (4a)
  • A Practical Guide to Private Exchanges, Health Watch, May 2015 (4a)
  • GH101-105-25: Ch. 7 (sections 7.1-7.3, 7.5-7.7) of Canadian Handbook of Flexible Benefits, McKay, 3rd Edition, 2007 (4a)

Source Material

Source Material

  • Video: The Variety of Short-Term Health and Group Benefits
    • Background
  • Video: Plan Sponsor Perspective
    • Background
  • Video: Actuarial Roles in Health
    • Background
  • Group Insurance, Skwire, Daniel D., 8th Edition, 2021
    • Ch. 3: Product Development (1d)
    • Ch. 5: Medical Benefits in the United States (1a, 1b, 1c)
    • Ch. 6: Dental Benefits in the United States (1a, 1b, 1c)
    • Ch. 7: Pharmacy Benefits in the United States (1a, 1b)
    • Ch. 11: Group Life Insurance Benefits (1a, 1b, 1c)
    • Ch. 20: Pricing of Group Insurance (2a, 2c)
    • Ch. 21: Estimating Medical Claim Costs (exclude Appendix: Data Sources) (2a, 2d)
    • Ch. 22: Estimating Dental Claim Costs (2a, 2c, 2d)
    • Ch. 23: Estimating Pharmacy Claim Costs (2a, 2c, 2d)
    • Ch. 35: Medical Claim Cost Trend Analysis (2a, 2b, 2c)
    • Ch. 24: Estimating Life Claim Costs (2a, 2c- 2e)
    • Ch. 26: Experience Rating and Funding Methods (3d)
    • Ch. 29: Group Insurance Underwriting (3a)
    • Ch. 30: Managing Selection in a Multiple-Choice Environment (3c)
    • Ch. 34: Health Risk Adjustment (pp. 579-585) (3b)
  • GH101-100-26: Chapter 5 of Individual Health Insurance, Leida, Hans, 3rd Edition, 2026
    • Outcomes 2b, 2c, 2d
  • Closing the Analytical Loop: Technology Assessments and Actuarial Methods, SOA Research Institute, Jan 2025
    • Outcomes 2c
  • ASOP 12: Risk Classification (excluding Appendices)
    • Outcomes 2f
  • ASOP 23: Data Quality (excluding Appendices)
    • Outcomes 2f
  • ASOP 25: Credibility Procedures (excluding Appendices)
    • Outcomes 2f
  • ASOP 41: Actuarial Communications (excluding Appendices)
    • Outcomes 2f
  • GH101-102-25: Types of COB and Impact on Medical Claim Data
    • Outcomes 3a
  • GH101-101-25: Illustrative Examples on Experience Rating and Funding Methods
    • Outcomes 3a, 3c
  • The Role of the Actuary in Self-Insurance, May 2018, Sections 4, 5 & Appendices (excluding 4.1.1-4.1.5, 4.4, 4.6.1-4.6.3 & Appendix D)
    • Outcomes 3a, 3d
  • Level Funding: An Alternative to ACA for Small Groups, Health Watch, May 2016
    • Outcomes 3a
  • Modeling Effects of Enrollee Choice, SOA, Jan 2021
    • Outcomes 3c
  • Calculated Risk: Driving Decisions Using the 5/50 Research, SOA Research, Jan 2025, Sections 1 (background only), 2 & 3
    • Excel Model: Calculated Risk (3e)
  • GH101-103-25: Health Plan Payroll Contribution Strategies and Development for Employers
    • Outcomes 4b
  • GH101-106-25: Ch. 2 & Ch. 24 of The Handbook of Employee Benefits, Rosenbloom, 7th Edition, 2011
    • Outcomes 4a
  • GH101-104-25: Recommend an Employee Benefits Strategy
    • Outcomes 4b
  • Consumers to the Rescue? A Primer on HDHPs and HSAs, Health Watch, Feb 2019
    • Outcomes 4a
  • A Practical Guide to Private Exchanges, Health Watch, May 2015
    • Outcomes 4a
  • GH101-105-25: Ch. 7 (sections 7.1-7.3, 7.5-7.7) of Canadian Handbook of Flexible Benefits, McKay, 3rd Edition, 2007
    • Outcomes 4a