Actuarial Notes

Group Insurance

By Daniel D. Skwire, Kristi M. Bohn, Margaret D. Cormier, Stephen J. Kaczmarek and Sara C. Teppema · ACTEX Learning · 2021

Study guides: Exam CP-321, Exam GH-101, Exam GH-201C, Exam GH-201U

A comprehensive treatment of all aspects of group insurance in the United States and Canada, in its eighth edition, edited by Daniel D. Skwire with William F. Bluhm as founding editor. It addresses life and health insurance as well as government programs and more specialized forms of insurance, with emphasis on the actuarial aspects of the field, including pricing, regulation, underwriting, financial reporting and modeling; the eighth edition adds chapters on Group Insurance Reserves and Estimating Pharmacy Claim Costs and a greatly expanded treatment of the Affordable Care Act.

On the syllabus

  • Exam CP-321 — Chapter 9, pp. 149-153 (Outcome 1d); Chapter 12 (1a-1c); Chapter 25 (2a-2d); Chapter 29, pp. 509-510 (2e); Chapter 40 (3a-3e, 3g).
  • Exam GH-101 — Chapter 3 (Outcome 1d); Chapter 5 (1a-1c); Chapter 6 (1a-1c); Chapter 7 (1a, 1b); Chapter 11 (1a-1c); Chapter 20 (2a, 2c); Chapter 21, excluding the Appendix: Data Sources (2a, 2d); Chapter 22 (2a, 2c, 2d); Chapter 23 (2a, 2c, 2d); Chapter 35 (2a-2c); Chapter 24 (2a, 2c-2e); Chapter 26 (3d); Chapter 29 (3a); Chapter 30 (3c); Chapter 34, pp. 579-585 (3b).
  • Exam GH-201C — Chapter 39 (Outcomes 1a-1e, 1g); Chapter 37 (2a, 2d, 2e, 2f); Chapter 43 (2a, 2b, 2c).
  • Exam GH-201U — Chapter 39 (Outcomes 1a-1e, 1g); Chapter 43 (2b, 2c); Chapter 41 (2d); Chapters 4 and 15 (3a); Chapters 16 and 17 (3a, 3b); Chapter 9, pp. 133-149 (4a, 4b); Chapter 19 (4c).

Preface

Section One Introduction

1 Introduction to Group Insurance

2 Overview of Marketing and Sales

3 Product Development

4 Health Policy and Group Insurance

Section Two Group Insurance Benefits

5 Medical Benefits in the United States

6 Dental Benefits in the United States

7 Pharmacy Benefits in the United States

8 Retiree Group Benefits

9 Government Health Plans in the United States

10 Health Benefits in Canada

11 Group Life Insurance Benefits

12 Group Disability Income Benefits

13 Group Supplemental Health Benefits

14 Group Health Insurance Outside North America

Section Three Legal and Regulatory Environment

15 Principles of Health Insurance Regulation

16 State Regulation in the United States

17 Federal Regulation in the United States

18 Regulation in Canada

19 The Affordable Care Act

Section Four Funding and Rating

20 Pricing of Group Insurance

21 Estimating Medical Claim Costs

22 Estimating Dental Claim Costs

23 Estimating Pharmacy Claim Costs

24 Estimating Life Claim Costs

25 Estimating Disability Claim Costs

26 Experience Rating and Funding Methods

27 Group Insurance Rate Filings and Certifications

28 Medicare-Related Rate Filings and Certifications

Section Five Underwriting and Managing Risk

29 Group Insurance Underwriting

30 Managing Selection in a Multiple-Choice Environment

31 Claim Administration and Management

32 Medical Care Management

33 Health Economics Data, Reporting, and Analytics

34 Health Risk Adjustment

35 Medical Claim Cost Trend Analysis

Section Six Group Insurance Financial Reporting

36 Group Insurance Financial Reporting in the United States

37 Group Insurance Financial Reporting in Canada

38 Group Insurance Reserves

39 Claim Reserves for Short-Term Benefits

40 Claim Reserves for Long-Term Benefits

41 Risk-Based Capital Formulas

Section Seven Financial and Actuarial Analysis

42 Applied Statistics

43 Analysis of Financial and Operational Performance

44 Enterprise Risk Management for Group Health Insurers

45 Management of Provider Networks

About the Editors

About the Authors

Index

Sources